• Background
• Purpose
• Test Administered
• Result – WISC III
• Result – TOVA
• Result – WORLD
• Conclusion
• Recommendation

Background

This assessment was recommended by the Consultant Pediatrician in addition to the hearing assessment. An updates on assessment for attentional difficulties or reading difficulties was required for the Consultant to evaluate the impact of hearing impairment on attentional and reading difficulties.

Purpose

Cause of concern:

• Ability to maintain attention
• Suspicions of difficulties in processing language

Test Administered

1. Wechsler Intelligence Scale for Children – Third Edition (WISC-III)
2. Test of Variables of Attention – (TOVA)
3. Wechsler Objective Reading and Language Dimensions – Singapore

Result – WISC III

Comprising a verbal subtests combine to provide an indication of verbal comprehension, verbal reasoning, verbal concept formation and verbal expression abilities, the child is observed to have difficulty holding different numbers in her short-term memory. When more challenging arithmetic word problems were presented visually instead of verbally, she was able to complete them very quickly. This suggests that she might have some difficulties with some aspect of auditory processing. A relatively lower score further suggest that auditory processing is an area of weakness for her.

The performance subtests combine to provide an indication of visual-motor ability, perceptual ability, non-verbal reasoning ability, and ability to attend to perceptual details. In this tests which allow the identification of her areas of strengths and weaknesses, child is found to have a good short-term visual memory but might have difficulties comprehending and evaluating social situations and/or visual sequencing.

Result – TOVA

TOVA is a computer-based test of visual and auditory attention. It provides information regarding the respondent’s ability to sustain both visual and auditory attention over time and to inhibit impulsive responding – two key areas fundamental to a diagnosis of an attentional disorder. Respondents are required to press a microswitch when presented with a target stimulus. Errors in terms of omissions and commissions are analyzed to provide information pertaining to attentiveness and impulsivity respectively. Examination of the test scores also provides specific information regarding the length of time for which respondents can sustain attention.

Child’s performance on the tests of both visual and auditory attention were not within normal limits. On the visual TOVA, her omission errors were excessive, indicating that she had difficulties maintaining visual attention. She also demonstrated difficulties maintaining auditory attention on the Auditory TOVA test. On the auditory attention test, she had difficulties resisting impulsive responding. Her pattern of responses (omissions and commissions) revealed a consistent tendency towards inattention and impulsivity which fall within the clinical range.

Additional note on the audiology test where it was found that child have difficulties listening in poor acoustic environments and with competing background noise. If the results of the TOVA test showed that child only demonstrated difficulties with auditory attention, then the previous diagnosis of attentional difficulties would be cast in doubt. However, as child was found to have problems with both visual and auditory attention, it appears that her problems maintaining attention are independent of, and in addition to, her difficulties perceiving sounds.

Result – WORLD

Assesses a child’s literacy and language skills. The subtests of the WORLD measure reading, spelling, reading comprehension, listening comprehension and oral expression skills. Performed very well on this test with literacy and language skills more than 2 years compared to her peers. Hence it is unlikely that child has language difficulties.

Conclusion

• Difficulties with auditory memory.
• Difficulties maintaining attention and resisting impulsivity

However, these are not currently manifested as behavioral problems. Overall, the picture is one of a child who is doing well in school in spite of her difficulties paying attention and listening clearly in the presence of background noise.

Recommendation

In the school setting, to accommodate auditory difficulties:

• Within the classroom setting, child be given a seat in front close to the teacher to ensure that her problems listening would not be compounded.
• In the classroom, child could be provided with visual aids whenever possible to supplement the auditory input. For example, key information like numbers or important words in strings of information delivered verbally could be presented visually, for example, on paper, for her. However, it is important that this be done discreetly, such that it does not draw unnecessary attention to her weakness.
• In academic testing, given her difficulties perceiving sounds, child would be unduly penalized if she were assessed through oral questioning. Her performance would not be a true reflection of her abilities. Thus, it is requested that test questions be presented visually instead of orally to child.
• Finally, child could be taught and encouraged to use visual strategies like visualization and mnemonic strategies like letter prompts to help her hold auditory information in her working memory.

In the school setting, to accommodate her visual tracking difficulties:

• To counter her reported difficulties visually tracking writing on the board and transcribing it on her worksheets/workbooks, it is requested that as far as possible, such tasks be reduced for child. Instead, photocopied versions of writing on the board could be made available to her. Alternatively, the writing to be copied could be placed on child’s desk such that she would not have to shift her focus visually and thereby lose her tracking. It is important that this be done in a way that does not highlight her difficulties.
• In assessment situations, given child’s difficulties tracking visually, she would be unduly penalized if the assessment tasks included getting her to copy and shift her focus visually from her desk to the board or OHP, for example. This would definitely affect her performance. It is thus requested that, to obtain a more accurate assessment of her abilities, photocopies of material to be copied be given to child instead.
• It is requested that all help rendered to child and accommodations given to her in the school setting be done in as innocuous a way as possible, such that it does not stigmatize her nor bring unnecessary attention to her difficulties.

To target her social rigidity

Due to her social rigidity, nuances in meaning and situational differences in social exchanges will have to be pointed out explicitly to the child. They will not be intuitively detected or conceived. An effective remedial approach incorporates constantly “spelling out” to her what other children would be able to pick-up or infer intuitively because this is the only way child will process and assimilate accurate observations of her environment.

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