Posts Tagged ‘psychological assessment


What’s in a word – A lot!

A subtest on nearly all measures of intelligence is Vocabulary.  So, on the Wechsler IQ scales (one is designed for children; one for adults) the Vocabulary Subtest consists of having the individual look at a printed word, pronounce it (assistance in pronunciation may be given) and then provide a definition of that word.

Margo was a 17-year-old in a private girl’s school.  She was laboring to obtain satisfactory grades, but her teachers were most perplexed by their belief that she “seemed” so much more capable than any of her test scores, especially on essay sorts.  They unanimously agreed that her “writing didn’t reflect her ability”, though their estimates of her ability were necessarily based on impressions and inferences, not on facts or test scores.

Early on in the Vocabulary test, Margo pronounced the word “conceal” and said (in almost invariably halting words and phrases), “to like close something up, closing all ends. . . concealing it. . . keeping it quiet, low-key. . . like a jar?. . keep tightly closed”.  When I asked her whether a person could conceal a gun, she instantly said, “Sure. . hide it. . by hiding it!”

Later, to   commence, she said, “to applause, to praise someone!” (commend?) and defined the word sentence, as “Like a bunch of words; it has a topic (subject) and a verb”. She involuntarily accessed the meaning of commend and found the wrong word for subject. She made these mistakes and others like them again and again, even though it turned out later that they were “not what I meant to say” (see below).

Later on, she defined much less frequent words with much greater sacuity.  She said tangible meant “palpable’, that remourse meant “guilt”  and that sanctuary was “a place to worship, a religious place”.

In the end, it became clear that Margo knew a lot more about word meanings than she could reliably explain or specify.  And instances of inefficient, misguided or tangential recall processes appeared across testing of of her verbal aptitudes.

I learned a lot from Margo and others like her.  I realized that “decontextualized” words (those presented in isolation) can, even for very bright Learning Disabled children, conjure up multiple and diverse” possible meanings”.  It’s as if they can access in memory not just conventional word meanings but also meanings peculiar to a certain circumstance.  What’s more,  other forms of a given word can spontaneously surface (e.g. “concealed” or “concealing” or “concealment”) and complicate the process of defining a word.  Too, words that are similar in sound (or spelling) can contribute their own features.  So, for Margo, “conceal” activated the word “seal” as well as “hide”.  So, the phrase, “conceal the jar” – without additional context, is ambiguous in meaning, at least for Margo.

One can observe just this sort of meaning/sound conflation in her definition of “commence”, which appeared to elicit the meaning of “commend” for Margo.  She subsequently “corrected” her definition when I said, “We commenced the meeting”, “Oh! she exclaimed.  “to begin something,” start it . . . I don’t know where I got ‘praise’ from . . .I’m sorry.  That’s so stupid!”

Margo got a low Vocabulary score; she got no points for words that later on, she instantly defined when I put them in context.

I had to report that score, of course.   But I spent considerable time explaining to the reader of my report why her score was a substantial underestimate of her true word knowledge.  And I explained how high-frequency words were more troubling for Margo than rarer words.  Why?  Because over the years, Margo had heard and read the former more frequently, in various contexts, all of which enriched and expanded their meanings, making their definitions intricate, context-sensitive and multi-layered. And her ability to search through this huge database was inefficient if not altogether undependable. Such languae memory difficulties are seen in many with language disorders.

In some sense, Margo knew “too much” about words, their phonetic structures and relationships, their grammatical features, and most of all, their multiple semantic components.  Her only “problem” was that, in academics, she was requird to “show” what she knew about words and meanings in artificially constrained, one-dimensional ways when little time and context were provided.


“It’s Right on The Tip of My Tongue”

Just yesterday, Vince, a 17-year-old from a prestigious private school, came for an Evaluation.  Soft-spoken, a bit self-conscious but wholly committed to doing his best, Vince demonstrated very sophisticated verbal aptitudes – faculties nearly essential in the particular school he attended where so many peers possessed superior abilities.

But Vince was struggling in school and seemed unable to overcome his diffuse but substantial achievement problems.

Though no pattern of deficits or even weaknesses emerged in the first of two test sessions, one interesting moment arose when I asked (as part of the IQ Battery’s “Information” subtest), “Who wrote ‘Great Expectations’?”

Vince shot up straight, clapped his hands together, snapped his fingers once and exclaimed, “Wait, I know this!  I KNOW I know it! Gimme a sec!”  But after some 40 seconds passed, after much grimacing and sighing and seat-shifting, he seemed to sag in his chair, as if he were deflating.  “I can’t think of his name.  I know it!  I know it!”  A moment later, he sighed deeply and groaned “Aw, I don’t know.”

At that point, I took out a piece of paper and asked him to guess how many letters were in the author’s last name.  At first, he looked amused, but after some encouragement, he said, “Uh, eight!”.  I said, “No, there are seven” and drew seven short dashes on the paper (like the kids’ game, “Hangman”)  The dialogue continued:

Me:  “How many letters are in his first name? “

 Vince:  “I’ll say seven”.  

ME:  “Right”  And I drew seven short dashes to represent the seven letters that Vince guessed were in the author’s first name.  Now, he was looking at two groups of seven dashes:

ME:  “What’s the first letter that comes to mind when you think of this writer?  Just guess.”

Vince:  “Okay, um…’I’?”

I put the letter “I” in the second dash of the last name group of seven

_ _ _ _ _ _ _  –  _I_ _ _ _ _.

ME: “Guess again.”

 Vince: “I dunno – ‘C”?

 I put the “C” in two spaces: C _ _ _ _ _ _  –  _IC_ _ _ _.

Me: “Next?”

Vince: “E”.

I put the two “E’s” in.  Now he was looking at:

C_ _ _ _E_  –  _ _ I C _ E_ _.

ME: “Any guess as to his name?”

Vince:  “No, not at all”.  

ME:  “Guess again”.

Vince:  “I keep thinkin’ “S'”.

ME:  “Right”  And I added the “S’s”

C_ _ _ _ES – _ IC_E_S.

ME: “Next?”

For the sake of brevity in this post, I continued to ask Vince to guess letters one by one,  and as he guessed a correct one, I inserted the letter in the appropriate space.  In order, he “guessed” the following letters, “D”, “K”,”A”, “N” and “R”.  He was now looking at:  C_ARLES DICKENS.

He’d guessed all the letters in the name without error, the number of letters in the name (OK, he guessed one extra space) . But he couldn’t recall the name !! How is it that he could take ALL those absolutely correct guesses ( and he was genuinely guessing as far as I could determine and he was concerned) and NOT KNOW THE NAME?

He looked again, threw his hands up in the air, smiled broadly but in some embarrassment, and nearly shouted, “Oh God! Charles Dickens, of course!”  Until that moment, he could not recall the name.

What Vince had been experiencing was what is popularly known as a mental block.  When this “block” occurs frequently in a person’s speech efforts, it is called “Dysnomia”  Often described as a “word-finding” difficulty, it entails spontaneous, inexplicable failures to recall names, dates, even math facts or word pronunciations on demand.  This disposition to “draw blanks” is not a manifestation of anxiety or an intellectual deficit.  It disrupts speech spontaneously and unpredictably in circumstances in which the speaker has to recall a name to answer a question or specify a particular object or person in a sentence he wants to communicate.

While it is fairly common for true Dysnomics to be able to recall individual letters or sounds of the desired name and while they often can specify facts associated with the desired name (e.g. Vince knew Dickens was an “English” writer of the 19th Century”), they all too commonly fail to “find”  names.  But later on, perhaps driving home or sitting in a chair watching TV, Dysnomics will spontaneously recall the name:  “It just popped into my mind!”

In future posts, I will describe how exasperating and  how frequently Dysnomia can impede academic achievement.  At the same time, I’ll review what I ultimately learned about Vince.  I don’t think he’s truly Dysnomic but…I’ve been wrong before. We’ll see.


Right Church, Wrong Pew

Liz wanted to be a nurse. And so she went to college, got her degree, then earned a Masters degree in Nursing at a prestigious university.  She graduated with a 3.95 GPA, with honors and everyone’s applause.

Finding immediate employment at a world-renowned hospital, she soon started to become depressed and anxious, disenchanted with the job though she loved working with other professionals and the patients. But the demoralization continued  and she sought therapy. The therapist referred her to me for evaluation. “Something doesn’t make sense,” the therapist said. “Liz is very bright, she’s  had a stable upbringing, has lots of friends, no trauma, no evidence of familial disposition to mood disorders. But she keeps complaining about the work, how nervous she gets. Maybe you can help clear up this matter.  She’s on medication, an antidepressant, but that’s not making much of a difference.  I’m at a loss.”

And so, a few days later, Liz entered my office.  Congenial, cheery, sophisticated and very mature in her ways, despite her youthfulness (she was 24), Liz seemed the epitome of all that makes up a competent and sensitive human being.  And she was hard-working, intent on doing her best on each task I presented her.  Her IQ reached into the 90th%ile+,  superior.  It would have been higher had she not obtained two remarkably lower scores. One was on a subtest called Digit Span, another on a subtest called “Arithmetic” .

Both are very sensitive to attention span. The possibility that an Attention Disorder was related to her depression soon occurred to me.  But more evidence was needed. So I asked some questions like the following;

1. Do you ever have to re-read something you’ve just read.

“All the time, even in high school and always in college.  I’d spend hours on homework!  I mean, I could read just one paragraph and then realize at the end of it that I was thinking of something else.  And then I’d have to re-read.  But that was OK. I never minded working hard.  I’m not really very smart if you want to know the truth.  I just work hard.”

2.  Do you make little mistakes, like forgetting to write some words in a sentence or miscalculate in math?

“Well, yeah. But they were never really a problem because  I’d double-check my work.  But I always hated math because no matter how many times I checked, an error would show up anyway, always a careless error, dumb, stupid. “

3.  How about lecture note-takng in college?

“I was OK if the professor didn’t talk real fast.  And I became a really FAST writer. I never participated in class because I was so focused on getting the notes that I couldn’t concentrate on WHAT the teacher was talking about.  Same thing with foreign language; I had to try really hard to remember what was said in French so I could translate it.  But I’d keep forgetting, and so my translations sucked.  I HATED French!”

I asked her about her nursing job.  I LOVE nursing, but… I…it’s getting to me, getting me down.”

And then the tears began, pained sorts, robbing her of the dignity and  self-possession she’d worked so hard to project.

” I have to give out all these medications, different dosages, sometimes three or more for some patients.  And I’d keep forgetting who got what.  And I’d study and study the dosage charts and names and still catch myself making dumb mistakes,  forgetting this or that. I’d spend hours reading and re-reading the charts.  But I was taking too much time, and the supervisors were getting on me because I was not giving enough attention to my patients.”

I was afraid I was going to hurt  somebody! “

Liz did have an Attention Disorder, quite severe.  It corrupted her ability to remember “little”  things, data, details, numbers and the like.  It compromised her efforts to monitor her work for “dumb” mistakes because those errors came so quickly, she didn’t know she’d made them; they were INvoluntary and so she could not know where her mistakes were.

Liz, at my encouragement, sought another position in Nursing, one that required far less charting and record-keeping, one where she had time to do her job well and with pride and satisfaction. Her depression lifted; it has not returned. She has become the very competent, sensitive and compassionate nurse she always wanted to be, that in truth she always had been.  In a Psychiatric position, she excels in her understanding of the human condition, of struggle and suffering, and her great empathy for her patients.  She found her calling.


Gifted and Learning Disabled?

Asymmetric Intelligence (note the scores above are derived from an older version of the Wechsler scales, It is displayed here to simplify the issues discussed in this posting. Later versions of the Wechsler scales, which I will address in subsequent posts, include "Index" scores that needlessly complicate the explication of the central issue in this posting: The differences between Verbal and Non-verbal Intelligence measures.

This set of IQ scores, including subtest scores, was obtained by a young man in his teens. He was angry, depressed , very sophisticated and confused. And he was brilliant and mediocre at the same time.

You should look at the difference between his  Verbal Score and his Performance Score. The former, Verbal, was of a magnitude shared by LESS  than FIVE in every THOUSAND kids his age; he was clearly gifted verbally.  His score far exceeded the mean even in his fast-paced private school setting, where the “average” was the 90th percentile. Even in this competitive milieu, he distinguished himself. His ideas were abstract, insightful, far beyond his years. He effortlessly generated fluent, grammatically complex and stunningly insightful comments and test responses, embedding in them vocabulary items both precise and scholarly. He read voraciously, debated issues with his teachers and refused to agree with things just because some authority said so. He loved TRUTH. He was respected, even awed by some of his teachers; he intimidated some with his astute reasoning and flawless logic.

But he was getting poor grades. He hated Science and Math. His writing was a scribbled tangle of lines and curves. He said he hated to write. His parents complained that he was disorganized, lazy, argumentative . But they loved him. “He’s a sweet boy,” his mother said. His father often discussed…and argued about…politics, the economy and especially morality, right and wrong. “He just seems frustrated all the time,” his father observed, just a hint of sadness in his voice. “He seems confused.”

Eric had good reason to be confused ! Look at his Performance score. About 50 of every 100 kids his age would score lower. BUT 50 would score higher. And so, in his high-powered, academically rigorous independent-school classrooms, he was well BELOW the average for that population. So, mathematical concepts like “square root” or “acute angle” didn’t make much sense to him. He could memorize formulas and procedures. But he couldn’t apply what he was learning. He couldn’t reason well at all when such concepts were involved.

When I asked him how far it was from New York to Los Angeles, he said “About 30,000 miles.” When I asked him to show me how big a “foot” was by holding his hands apart, the space he produced between hands was a good three feet. On an outline map of the U.S., he drew the Mississippi River horizontally from Texas to California. He “lost” things, he said. “I can never remember where I put something.” And though he was close to getting his driver’s license, his parents worried because he got lost so easily and couldn’t read maps at all.

Because what the Performance subtests measure, the ones called  Block Design, Object Assembly , Coding, etc .(see above), is NON-VERBAL abilities.  Notions of abstract space, proportion, orientation, direction, even time participate in these Performance functions. And so, when weaknesses and deficits occur in them, concepts like “The day after tomorrow” or “bilateral symmetry” or “atomic shells’ , even  left-right , the order of months in the year, ratios and congruency become nearly impenetrable mysteries because they cannot be “pictured”, because the word and terms connect with NOTHING or only the most nebulous of mental representations. Handwriting is sloppy, planning efforts are perfunctory and athletic competition is minimized.

Eric could, I guess, be called gifted-learning disabled. He was rare, rarer than many a gifted child, but common enough for me to have seen quite a few over the years. In later posts I’ll discuss what becomes of such individuals, what can be done to support them, what they can do themselves.

I explained a lot of this to Eric in a conference after testing. His parents asked me to. He had a thousand questions. He smiled a lot.


Dysgraphia: An Unforgiving Learning Disability

NOTE: The reader is asked to examine the writing sample following the text below. “Zooming” in will help in examining the errors cited below.

Dysgraphia is a Learning Disability characterized by deficits in handwriting and spelling. In the sample below, Nick executes a variety of errors  he incurred while trying to copy text. What you see is the amount of text he copied in 120 seconds, statistically, a second grade level equivalent…though Nick was 11 years old in the 5th grade. The numbered arrows identify malformations caused by poor grapho-motor coordination. For instance, Error # 1  illustrates a spontaneous reversal of direction, a leftward move as he began the letter “o” that Nick simply terminated AFTER he noticed it was wrong. Dysgraphics cannot depend upon the sense of touch or direction of motion that a functioning writer takes for granted. That is, even young writers know when they’ve made a mistake even BEFORE they see it because they unconsciously  compare what they INTEND to write against what they sense their hand is doing. This sort of “motor feedback” is what typists depend on as they type; they only occasionally check their work visually.

Estimating spatial constraints is clearly difficult for Nick. Err0r #14 reflects his mistake in estimating how much space he would need to use to write the word “brought” . Note how he “handles” this by splitting “brought” into broug and ht. Nick’s  spatial mis-estimates can also be observed in the inconsistent spacing of written lines. His erasure of the “n” in “an”, Error # 12, typifies an “anticipation” mistake. He knew he was going to follow the article “a” with the word “new”, but he executed the “n” of “new” ahead of time, ahead of the space that should have been there. Here, he simply erases the “n”, again AFTER he sees it.

While I could explicate several other sorts of Nick’s grapho-motor mistakes (e.g. his poor grasp of letter “bridging” :cf. Errors 4, 13, and 9), the major issue for Nick is the overwhelming frustration he must experience as he tries to write. Recall that his verbal intelligence EXCEEDS that of 90% of his age-peers and that such ability permits Nick to enjoy sophisticated abstract thought, rapid vocabulary growth and the oral language capacities of a 13 or 14-year-old. Recall also that here Nick is simply copying something. Imagine his frustration and demoralization when he attempts to communicate his own ideas in written form, in “neat”, “accurate” handwriting, correct spelling and punctuation, all legibly and automatically performed. To do the latter, he must work VERY slowly, very slowly, ever tracking, checking the “formal” features of his work, constantly miscuing, ever unsure of the spellings of words he so effortlessly uses in oral communication. That he says he “hates” writing is understandable; indeed, it is quite reasonable. For Nick, for all dysgraphics, this learning disability silences them even as it exposes them to relentless admonition, criticism and demeaning comments from teachers and insensitive, uninformed or mean-spirited parents.

After Nick could exploit computer technology and writing applications, he began to enjoy communicating his thoughts on paper. And as he finally displayed his intelligence in written form, others noticed, invited him into their academic communities and awarded him a Masters Degree in Comparative Literature some 12 years after he laboriously copied the above.



Mothers DO Know Best

Parents know their children very, very well. And while fathers are good at acquiring this knowledge, mothers know the most, to the greatest depth, in the greatest detail.

I am not able to explain this phenomenon. But when mothers sense something is “wrong”, their “sense” is remarkably accurate, much moreso than the impressions of “professionals” who teach or test them.

How mothers acquire this knowledge is remarkable because they have NOT had the opportunity to compare their children to other children except by brief, informal observations of those others. Yet, their descriptions and inferences about their own children are almost invariably true. Somehow a mother “knows” when her child is depressed, angry, confused, happy, demoralized, fearful, or excited. Moreover, a mother knows what circumstances and activities elicit these different states in her child.

Of course, a facile explanation is that a mother spends a lot of time with her child and gradually learns patterns. But that explanation is extremely simplistic. To identify demoralization in a child, for instance, entails repeated, close  observations of that child in widely varying circumstances and then somehow aligning the properties of certain circumstances with the many ways that emotions can be physically expressed (e.g. by a change in facial expression or voice tone or body position, or all of these combined) . She must discriminate between “shows” of demoralization and genuine indicators of demoralization. This particular discrimination is one even the most experienced, sensitive “professional” can miss altogether…understandably, since it takes so much time to learn these distinctions. That is why I invariably advise mothers to believe what they feel, to trust their own judgments and intuitions and to question closely those specialists and teachers and psychologists when these latter make pronouncements about their children.

One of the most common experiences a mother has is when a teacher tells her that her child is “doing fine” in school when the mother senses he/she is not. Worse,  a child can be labeled “inattentive” (or even ADD by a psychologist) when the mother believes he/she is bored. So often the mother’s opinion is trivialized, treated with a dismissive and patronizing “I understand; he/she is your son/daughter so you don’t want to acknowledge his/her problem” and patted on the hand.

But mothers KNOW.  Sometimes, they can be convinced that they CAN’T know, that the professionals know better because, well they’re “trained” and “experienced”.  And so, I constantly exhort mothers to believe in themselves. For in the end, THEY ARE the EXPERTS.


Want to Learn Something About a Person? Look at His/Her Mistakes.

Years ago, I warned my then three-year-old daughter to “behave” when she went to visit her little friend down the street. Without pause, she chirped brightly, “OK, Daddy! I’ll be very have” (it rhymed with “save”). And she ran out before I could respond.

But her comment lingered. She’d NEVER heard that word before all by itself. Sure, there was “have” as in “I have a cold”; but her “have” rhymed with “save” and that had never been said anywhere, in any version of English I’d ever heard on this continent. Was she hallucinating? Hearing impaired? Was I a bad parent? Was my Baltimore dialect corrupting her?

But then I thought, “Wait a minute! She just INVENTED a word! How’d she do that? “It blew away the theory that children learn language from hearing and imitating it . Here she was happily and confidently uttering nonsense.

Then, a few weeks latter, my son asked for a “yapple” (“apple” with a “y”). Yapple?! What?!

I’m sure there were many other nonsense things they said, mistakes that I wrote off as “cute” or that I simply didn’t really attend to, the same way we DON’T attend to the speech miscues of foreigners, drunks, people with speech impediments and the nonsensical gibberish of other people’s three-year-olds.

But I wouldn’t let it go. And then, I figured it out! What she had done was segment the word “behave” into two words: “be” and “have”. Then, she assigned “be” the grammatical status of VERB. Then, recognizing that in commands,” be” is followed by an adjective, she assigned her second word (i.e.:”have”) the grammatical status of ADJECTIVE.  She’s heard commands like, “Now you be good” or “Be quiet” or “You be nice” and so, concluded that “have” went in that same adjectival category. From there, it was an easy move to put an “intensifier”(in this case “very”) in front of “have” and create the novel, never-utttered, never-heard-before statement, “I’ll be very have!” She figured if you can be very good, very nice, very quiet, you can also be very “have”. What I failed to ask her was, “So when you’re have, what are you doing?” Lamentably, I never got the chance; she grew up too fast. But I’ll bet she was very “have” when she visited her little girlfriend next door. She was…still is… very “have” as far as I’m concerned. But with that “cute mistake” she revealed an astonishing mastery of phonology, morphology, syntax and grammar…and an equally astonishing ability to exploit that knowledge to generate novel utterances… which all of us do effortlessly every day.

But what about the “Yapple”. Well, if you say “The apple” to yourself, you’ll hear a long “e” sound at the end of “the” because  the article “the” comes before a word beginning with a vowel “apple” (compare “the train” with “the engine”; the first “the” is like “Thuh”, the second is like “Thee”.)  Now,  when the second “the” is pronounced, the front part of the tongue moves toward the same place that “y” is made, near the hard palate. When this happens, the final sound in “the”(thee)  is actually “y.” Listen to the way you say “the owl” or “the elephant”. It’s not that you can’t say “thuh owl”; it’s just that “thee owl” is somehow easier. So when my son INVENTED the word “yapple”, he was articulating his analysis of “the apple” because he’d heard “th” + “ee” +”y” +” apple” and logically presumed he heard “yapple”.

And that’s when I began to appreciate not just the extraordinary linguistic sophistication of very young children. I also realized that mistakes are enormously informative, inviting one to pay attention to mistakes, to figure out where they came from and why and how. They are invitations to understanding and eureka moments. And I’ve been welcoming their appearances ever since!