1. 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

2. Potential Conflicts of Interest None

3. 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: 2 nd edition John Wiley and Sons, Inc., 2009.

4. 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 5 th 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

5. 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

6. 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.

7. 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

8. WISC-IV FSIQ Similarities Vocabulary Comprehension Information Word Reasoning Block Design Picture Concepts Matrix Reasoning Picture Completion Digit Span Letter-Number Seq. Arithmetic Coding Symbol Search Cancellation VCI WMI PRI PSI

9. 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

10. 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

11. 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

12. 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?

13. 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.

14. 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.

15. 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 desk candletable lamp beach ball basketball hoop chalkboard

16. Perceptual Reasoning Index Matrix Reasoning (MR): The child looks at an incomplete matrix and selects the missing portion from five response options. Ex.

17. 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

18. 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.

19. 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

20. 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?

21. 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.

22. 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:  YES NO target group search group

23. 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. Processing Speed Index

24. Thomas Nine years old – 2 nd 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

25. 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

26. WISC IV Test Data 02/29/12 and 03/08/2013

27. 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.

28. 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.

29. 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.

30. Thank You

31. Contact Information Ted Kadet, OD, FCOVD Hope Clinic 12301 NE 10 th Place, Suite 302 Bellevue, WA 98005 Ph: 425-462-7800 Fax: 425-455-3019 Email: tsk@hopecliniconline.comtsk@hopecliniconline.com Website: www.hopecliniconline.comwww.hopecliniconline.com

32. Initial Vision Evaluation and 1 st Progress Evaluation

33. 2 nd and 3 rd Progress Evaluations

34. 4 th and 5 th Progress Evaluations

35. 6 th and 7 th Progress Evaluations

36. Most Recent Vision Evaluation

37. Psychological Report – pages 1 and 2

38. Psychological Report – pages 3 and 4

39. Psychological Report – pages 5 and 6

40. Psychological Report – pages 7 and 8

41. Report – WISC IV Re-test