**10. Child 1's profile on the WISC IV (UK)**

b/d Reversals; n/m confusion.

130 Learning Disabilities - An International Perspective

Good visualisation abilities.

Spatially competent child.

Interest in lego and computers.

and in the Bender Gestalt test.

These results are reported below.

based intervention programme was implemented.

*9.1.2. Strengths highlighted in initial interview*

*with analysis of performance on pragmatic language tasks*

Social abilities and friendships at school.

Familial difficulty (dad also had learning difficulties as child).

*9.1.3. Results from initial sessions of observation of performance on tests of basic skills combined* 

Buck's House Tree Person Test, the Bender Gestalt Test, the Peabody Picture-Language Vocabulary Test, the Schonell One Word Spelling Test, the Holborn Reading Scale, the Daniels and Diack Sentence Reading Test (as performance on the Holborn was low), the Schonell One Word Spelling Test and the Schonell Graded Dictation Tests (Tests A and B). The test-based evidence was supplemented by pragmatic language tasks involving (a) analysis of a spontaneous writing sample, (b)

Child 1 presented with one word reading difficulties, sentence reading difficulties, one word spelling difficulties, sequential spelling difficulties and problems with sound/letter associations indicating difficulties with phonics. There were a number of reversals in writing (b/d) as well as confusion of n/m. Observation indicated that Child 1 had attentional and focus difficulties and was very active. Emotional indicators were also present both in Child 1's drawings

As there were a number of indicators of potential learning disability in the case history as well as in the evidence from the two initial sessions conducted with Child 1, a diagnosis of learning disability with attendant difficulties in reading, writing and spelling was made. As there was evidence of fluency-based difficulties affecting accuracy and rate of reading, as well as evidence of difficulties with rate and spelling of written work, recommendations were made for more in-depth testing to establish Child 1's cognitive profile, ongoing assessment by the family's neurologist,<sup>12</sup> as well as testing using the phonic inventories [207–209] to establish Child 1's pattern of phonic errors.

12Child 1 had symptoms of focus and attentional difficulties due to immaturity in the myelinisation process, as well as accompanying attentional lapses and cortical irritability. He was treated for each of these symptoms by Dr W.G. Maxwell, neurologist, of Sandton Clinic, who assessed Child 1 on a six monthly basis throughout the period the fluency-

The following tests were administered in the initial sessions with Child 1:

analysis of school books and (c) analysis and comprehension of a picture story.

High anxiety levels.

Child 1's performance on the different subtests of the WISC IV (UK) [210] is summarised in **Table 2**, which presents the profile of standard scores obtained in the verbal comprehension, perceptual reasoning, working memory and processing speed areas of the test.

Child 1's performance in all areas of the test was in the normal range. However, there was evidence of scatter in level of performance both within and across different areas of the test. The verbal comprehension profile indicated that Child 1 had well developed vocabulary, a good level of general knowledge and well developed verbal reasoning abilities, but had difficulties with verbal classification and comprehension. The high scores on the perceptual reasoning side of the test indicated well developed perceptual and spatial abilities, with weakness in non-verbal reasoning, whereas the scores on both the working memory and the processing speed areas of the test indicated good sequencing abilities.

As scatter is indicative of strengths and weaknesses in particular types of cognitive and language processing, this confirmed the diagnosis of learning disability. The indications were that Child 1 was a spatially competent child with particular strengths in sequencing and working memory, which could be used as the basis for interventions to improve his functioning in writing and spelling. The conclusion was that the tests of basic reading, writing and spelling skills already conducted fell well below would be expected in terms of age level as well as overall level of cognitive performance, enabling diagnosis of a reading disorder under DSM-IV code 315.00<sup>13</sup> and a disorder of written expression in terms of the diagnostic criteria for DSM-IV code 315.2.<sup>14</sup>

There were also emotional, as well as focus and attentional indicators in the profile. Child 1's attentional difficulties were corroborated by reports from his parents and also from school,

<sup>13</sup>In terms of ICD DSM IV diagnosis, assessment of reading difficulties would normally be conducted on Axis IV, which would aim to identify psychosocial stressors, as well as psychosocial and environmental problems affecting reading ability on a functional level. Reading difficulties would then be classified under reading disorders, corresponding to ICD-10 code F81.0 and DSM-IV code 315.00, as follows:

A. Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person's chronological age, measured intelligence and ageappropriate education.

B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require reading skills.

C. If a sensory deficit is present, the reading difficulties are in excess of those usually associated with it.

If a general medical (e.g., neurological) condition or sensory deficit is present, Axis III on the ICD DSM IV would also be used for classification purposes. This axis aims to identify underlying medical or neurological conditions which may influence reading ability (e.g. attentional or concentration difficulties, especially those associated with cortical immaturity or slow myelinisation associated with poor connectivity) [199, 211, 212].

<sup>14</sup>The diagnostic criteria corresponding to ICD-10 code F81.2 and DSM-IV code 315.2 for diagnosis of a disorder of written expression are as follows:

A. Writing skills, as measured by individually administered standardized tests (or functional assessments of writing skills), are substantially below those expected given the person's chronological age, measured intelligence and ageappropriate education.

B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g. writing grammatically correct sentences and organized paragraphs).

C. If a sensory deficit is present, the difficulties in writing skills are in excess of those usually associated with it. As with Code 315.00, if a general medical (e.g. neurological) condition or sensory deficit is present, the condition would then be coded on Axis III [213, 214].


Note that 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 2.** Profile of Child 1 on WISC IV (UK).

where Child 1's teacher had flagged his attentional difficulties in the classroom, and was indicating that he was likely to fail Grade 3. The emotional lability was confirmed by reports from Child 1's parents, which indicated that he was frustrated by his difficulties at school and was subject to mood swings as well as emotional outbursts at home.
