Case Study: Changes in

Wechsler Intelligence Scale for

Children (WISC – IV) Scale Scores
following Vision Therapy for
Accommodative Esotropia
Theodore S. Kadet, OD, FCOVD
College of Optometrists in Vision Development
Annual Meeting – April 16, 2016
St. Louis, MO
 Potential Conflicts of Interest

• None
 Brief History of Intelligence Test
Development

• The following brief history is condensed from:

• Flanagan, Dawn P., and Kaufman, Alan S.,
• Essentials of WISC®-IV Assessment: 2nd edition
• John Wiley and Sons, Inc. , 2009.
 Brief History of Intelligence Test
Development
• Sir Francis Galton – sensory and motor tasks
• Alfred Binet – language oriented, emphasizing
judgment, memory, comprehension and reasoning.
Binet-Simon Scale led to Stanford-Binet IQ test
• Lewis Terman – adapted French test to American
culture. Stanford-Binet Intelligence Scales – now in 5th
edition
• In World War I, Army needed method to select officers
and place recruits. Terman and other Army
psychologists use Stanford-Binet to developed verbal
group-administered IQ test – called Army Alpha
 Brief History of Intelligence Test
Development (cont.)
• Problem with immigrant recruits who spoke little
English, so Army psychologists develop a group,
non-verbal test called Army Beta
• Later, Army psychologists develop individual
administered Army Performance Scale
Examination – non-verbal tasks from that Scale
found in tests today
• David Wechsler integrates the measures from the
Stanford-Binet/Army Alpha and Army
Performance Scale/Army Beta into Verbal and
Performance Scales
 Brief History of Intelligence Test
Development (cont.)
• Wechsler looking for dynamic clinical information,
beyond just psychometric tools. Develops Wechsler-
Bellevue Adult Intelligence Scale (1939), Form II of this
test led to the WISC in 1949. Used to evaluate
intellectual functioning in school-age children. PL 94-
142 (1975) increases need for intellectual and
educational testing
• WISC revises as WISC-R by Wechsler in 1974.
Psychological Corporation revises as WISC III in 1991,
and as WISC-IV in 2003. WISC–V, released in 2014,
utilizes computer and Internet scoring.
 Presenting the WISC IV

Credit for the following WISC IV PowerPoint

presentation to the HT 820 course at:
Indiana University-Perdue University
Indianapolis Campus
www.iupui.edu
 WISC-IV
Similarities Block Design
Vocabulary Picture Concepts
Comprehension Matrix Reasoning
Information Picture Completion
Word Reasoning

FSIQ

Digit Span Coding

Letter-Number Seq. Symbol Search
Arithmetic Cancellation
 Verbal Comprehension Index

Similarities (SI):
The child is presented with two words that
represent common objects or concepts and
describes how they are similar.

Ex. Milk – Water

Frown – Smile
Space – Time
 Verbal Comprehension Index

Vocabulary (VC):
For picture items, the child names pictures that are
displayed in the stimulus book. For verbal items,
the child gives definitions for words that the
examiner reads aloud.

Ex. (picture) train

(verbal) umbrella, absorb, garrulous
 Verbal Comprehension Index
Comprehension (CO):
The child answers questions based on his or her
understanding of general principles and social
situations.

Ex. Why do people brush their teeth?

Other concepts assessed:

apologize, copyrights, democracy
 Verbal Comprehension Index

Information (IN):
The child answers questions that address a broad
range of general knowledge topics.

Ex. How many legs does a dog have?

Who was Confucius?
Where does turpentine come from?
 Verbal Comprehension Index

Word Reasoning (WR):

The child identifies the common concept being
described in a series of clues.

Ex. This is used to dry yourself after a bath.

These are protected by skin and bones…
And can sometimes be replaced.
 Perceptual Reasoning Index
Block Design (BD):
While viewing a constructed model or a picture in
the stimulus book, the child uses red-and-white
blocks to re-create the design within a specified
time limit.

Ex.
 Perceptual Reasoning Index
Picture Concepts (PC):
The child is presented with two or three rows of
pictures and chooses one picture from each row
to form a group with a common characteristic.

Ex.
student
candle table lamp
desk

basketball
beach ball chalkboard
hoop
 Perceptual Reasoning Index
Matrix Reasoning (MR):
The child looks at an incomplete matrix and selects
the missing portion from five response options.

Ex.
 Perceptual Reasoning Index

Picture Completion (PCm):

The child views a picture and then points to or
names the important part missing within a
specified time limit.

Ex. pencil without lead tip

pig without nostril
river/bridge without waves on one side
 Working Memory Index
Digit Span (DS):
For digit span forward, the child repeats numbers in
the same order as presented aloud by the
examiner. For digit span backward, the child
repeats numbers in the reverse order of that
presented aloud by the examiner.

Forward length ranges from 2 to 9.

Backward length ranges from 2 to 8.
 Working Memory Index
Letter-Number Sequencing (LN):
The child is read a sequence of numbers and letters
and recalls the numbers in ascending order and
the letters in alphabetical order.

Ex. 5-A-2-B AB25 or 25AB

S-3-K-4-Y-1-G 134GKSY or GLSY134

 Working Memory Index
Arithmetic (AR):
The child mentally solves a series of orally presented
arithmetic problems within a specified time limit.

Ex. (Picture): How many nuts will be left if each

squirrel eats one?
(No picture): If I cut an apple in half, how many
pieces will I have?
 Processing Speed Index
Coding (CD):
The child copies symbols that are paired with simple
geometric shapes or numbers. Using a key, the
child draws each symbol in its corresponding
shape or box within a specified time limit.
 Processing Speed Index
Symbol Search (SS):
The child scans a search group and indicates whether the target
symbol(s) matches any of the symbols in the search group
within a specified time limit.

Example:

zx bvpfk YES NO
target group search group
 Processing Speed Index

Cancellation (CA):
The child scans both a random and a structured
arrangement of pictures and marks target
pictures within a specified time limit.

In this exercise, a page is covered with pictures of

animals and other common objects, either
randomly scattered on the page or arranged in
rows and columns. The child then marks through -
or cancels - the animals as quickly as possibly.
 Thomas
Nine years old – 2nd grade
Doing poorly academically – Mom takes for
Psychological and Educational Testing – WISC
IV part of testing battery
Psychologist recommends Vision Evaluation by
Developmental Optometrist
Mom requests WISC IV re-testing by same
Psychologist after one year of Vision Therapy
 Vision Therapy Treatment
• Customary Hope Clinic treatment protocol for
Accommodative Esotropia, including:
• PUSH PLUS
• Bifocal RX
• Emphasis on Accommodation and Convergence
ranges and flexibility
• In-Clinic VT sessions – one time per week
• Home-centered VT regimens
• Periodic Progress Evaluations
 WISC IV Test Data
02/29/12 and 03/08/2013
 Variables
Vision Therapy only variable during the
treatment year. No changes in other aspects of
Thomas’ life:
Stable home – no changes in lifestyle
Same school
Same diet
Same fights with sister, etc.
 Following Slide Presentation
Following this slide Presentation are:
Slides with copies of the Initial Vision Evaluation
Findings, Progress Evaluation Findings, and
most recent Vision Evaluation findings
Slides containing the Initial Psychological Report
and brief Report of the WISC IV re-testing.
 Chart Notes

Chart Notes for the individual Vision Therapy

treatment sessions are available for download
as a pdf in the Health Professionals Section on
the Hope Clinic Website.
Thank You
 Contact Information
• Ted Kadet, OD, FCOVD
• Hope Clinic
• 12301 NE 10th Place, Suite 302
• Bellevue, WA 98005
• Ph: 425-462-7800
• Fax: 425-455-3019
• Email: tsk@hopecliniconline.com
• Website: www.hopecliniconline.com
Initial Vision Evaluation and 1st
Progress Evaluation
2nd and 3rd Progress Evaluations
4th and 5th Progress Evaluations
6th and 7th Progress Evaluations
Most Recent Vision Evaluation
Psychological Report – pages 1 and 2
Psychological Report – pages 3 and 4
Psychological Report – pages 5 and 6
Psychological Report – pages 7 and 8
Report – WISC IV Re-test