I. Introduction: Tests commonly utilized for evaluating visual perceptual skills are indispensable for evaluating and diagnosing delays or lags (synonyms) in vision perceptual development in children. Most of these tests are designed for children five and above. Most have norms established at younger ages, but the test is difficult to administer to children that young (trust me!). 

A.The advantages of standardized testing are obvious:

1) A nation wide pool to compare your patient's score.

2) A high level of control between each specialist administering the test (ie. follow the directions!).

3) Avoidance of personal (and professional) bias from entering into your evaluation of the patient.

B. Standardized tests, however, cannot replace our diagnostic and observational abilities as professionals. Some of the disadvantages of standardized tests include:

1) Observations of the child's general behavior do not enter into the test scoring in most vision tests (we will discuss this issue in the next lecture).

2) Observations of the method the child used to arrive at a particular answer usually does not enter into the scoring in most vision tests. The product is emphasized; the process is not.

 

II. The following three tests are fairly widely used as standardized tests for laterality/directionality.

A. Jordan Reversal Test: consists of three parts. The first part has norms established from 5-12. Part IIa and IIb have norms established from 9 through 12. This test measures laterality and directionality skills.

1. Administration:

a. fill out the form for demographic information

b. directions:

i. Part I (5-12years):

- knowledge of the term "backwards"

- place a mark through the letters that are backwards

- work to "STOP"

- repeat rules for number section

ii. Part IIa (9-12):

- word or words in each row have letters that are backwards

- mark through the word(s) with backward letters

iii. Part IIb (9-12):

- word or words in each row may be backwards and make the sentence have little meaning

- mark through the word(s) spelled backwards

2. Scoring: Errors are counted. Two possible ways a child may respond incorrectly:

a. a correct letter or word is marked as reversed- false positive

b. a reversed letter or word is not marked as reversed- false negative

c. the total error score for each section are tabulated and compared to normative data (which is presented in the manual).

i. norms exist for ages 5-8 and 9-12 (those children under 9 take only part I)

ii. a separate norm established for males and females

iii. the lower limits of the "expected" range for a particular age is highlighted in light gray

iv. a percentile is determined from the chart

B. Reversal Frequency Test (Gardner): this test is older, but uses a different format. It has three sections and allows the patient to actually construct letters. It is generally considered to be an "easier" test than the Jordan.

1. Administration: Section I and II are to be given to each child

a. section I: the child writes down numbers and UPPER CASE letters that are read to him

b. section II: the child discriminates between pairs of letters/numbers. He/she is to mark through the reversed symbol of the set

c. section III: the child must match a template symbol (number or letter), to one of 4 alternatives presented

2. Scoring: errors in letter construction (pt. I), in letter discrimination (pt. II) or letter matching (pt. III) are tabulated.

a. norms exist from the age of 5-15 for parts I and II

b. norms exist from the age of 5-9 for part III

c. separate norms exist for male and females

d. separate norms exist for each sub-test

e. by the age of 8, most "normal" children make very few, if any, errors on section I

f. by the age of 7, most "normal" children make very few, if any, errors on section III

g. by the age of 8, most "normal" children have around 2-3 errors in section II. These errors remain present to the age of 12.

C. The Test of Lateral Awareness and Directionality (LAD): this is designed for the older child who may exhibit poor laterality/directionality skills.

1. Administration: this is a fairly unusual test in that there are no established age related norms. It is a criterion based test (as will be seen later). It comes in two sections; a laterality awareness subtest (15 items) and a directionality subtest (20 items).

a. there are a series of pictures to be shown to the child, and the child must make laterality/directionality decisions based on the instructional set.

b. the instructional set is listed for the administrator on the reverse side of each plate (item). The instructions are read to the child

c. the child chooses between 4 alternatives the single correct answer for each item

i. for older children: record answer on a score sheet

ii. for younger children: point to correct alternative on the plate

d. the items get progressively harder as you go from low to high numbers in each subtest

e. the complete test is given to each child

2. Scoring: errors for both subtests are calculated

a. a lateral awareness score is established

b. a directionality score is established

c. a composite LAD score is calculated by summing the two subtest scores

d. three levels of development of lateral awareness and directionality skills have been established; they are based on criteria only and do not look at the child's age

i. Level I Undeveloped:

-Lateral Awareness (LA) scores ² 10 (ie. five or more errors)

-Directionality scores (D) ² 13 (ie. seven or more errors)

ii. Level II Moderately Developed

-Lateral Awareness (LA) scores 11-13 (ie. 2-4 errors)

-Directionality scores (D) 14-18 (ie. 2-6 errors)

iii. Level III Fully Developed

-Lateral Awareness (LA) scores 14-15 (ie. 0-1 errors)

-Directionality scores (D) 19-20 (ie. 0-1 errors)

D. The Test of Pictures/Forms/Letters/Numbers/Spatial Orientation and Sequencing Skills by Morrison Gardner: A real nifty test for determining the development of a child's spatial orientation system. It has norms established for it (in two month intervals). Most parts of this test are normalized between the ages of 5 and 9. Many sub-tests are most appropriate for the child under 8. In cases of older children, this test can be used as a criterion based metric. A child by the age of nine or so should be able to complete this exam without error. If they cannot, it indicates an underdeveloped spatial orientation and sequencing skills

1. Administration: there are seven sub-tests to the Gardner, some of which are identical to some items found in another vision perception test he developed; the TVPS (discussed later)

a. section one (spatial relations (pictures)) consists of ordinary pictures and the child chooses which one of 5 similar pictures is flipped or rotated

b. section two (spatial relations (symbols))consists of symbols not tied to language. Besides that feature, it is identical to section one

c. section three (reversed letter and number of two letters and numbers) consists of a series of pairs of letters (both capital and lower case) and numbers, one of wich is backwards. The child chooses (with an X) which of the pair is backwards

d. section four (reversed letter(s) in words) consists of a series of words, some having backwardletters in them. The child is to choose (with a X) only the backward letter

e. section five and six (reversed letters/numbers from non-reversed letters/numbers) consists of a page of letters and a page of numbers. The child is to mark the backwards numbers/letters(this is indentical to the first part of the Jordan)

f. section seven (letter sequencing) consists of two chains of letters divided into two columns (A and B). The child is to look at the letters in column A and compare them to the ones in column B. If they are in the same sequential order, the child is to go on to the next row. If there is a different sequence in column B, the child is to mark that row (with a X) and go on

III. Tests Of Non-Motor Vision Perception Skills:

A.The Test of Visual Perceptual Skills (Non-Motor) [TVPS]: tests measure form recognition/discrimination, visual memory, visual sequential memory, visual figure ground and visual closure skills

1. Administration:

a. it is important to choose the sub-tests appropriate for the child. I usually like to perform this test after I have observed the child work on other tests for a period of time. Then the particular sub-tests can be completed. It is rare to complete all sub- tests.

b. fill out the form for demographic information: age is rounded to the nearest month

c. directions for each sub-test are conveniently printed at the beginning of the section

d. a brief description of each sub-test is offered below:

i. visual discrimination: choosing an exact copy of the template from other alternatives that are similar (which form is the same?)

ii. visual memory: the ability to remember characteristics of a template and select the exact copy from other alternatives

iii. visual-spatial relationship: choosing among alternatives the form that is different (which form is different?)

iv. visual form constancy: finding a representation of the template from other alternatives; the representation of the template may be rotated, flipped, enlarged or reduced in size

v. visual sequential memory: the ability to remember a sequence of visual forms and select the exact copy from other alternatives

vi. visual figure-ground: the ability to choose a copy of the template that has been hidden in a conglomerated ground of matter

vii. visual closure: the ability to match a completed template to its uncompleted "skeletal"match.

e. present test items to three consecutive errors are made (ceiling level is reached)

2. Scoring the TVPS: norms are established for ages 4 through 12 (in 4 month increments

a. Raw scores are based on how many correct responses made.

b. Scaled scores are obtained by looking up the child's age in Table 17 (in the manual) and finding a particular scaled score for the raw score in each sub-test.

c. Percentile rank can be found in Table 17 as well.

d. Visual perceptual age can be made by finding the raw score for each sub-test and looking up the visual perceptual age in Table 19

B. The MVPT: a similar, but shorter test of non-motor visual perceptual skills. It is an older test.

IV. The Visual-Motor/ Eye-Hand Coordination Tests:

A. The Beery Visual Motor Integration Test: tests visual motor integration/form reproduction skills.

1. Administration:

a. Fill out the form for demographic information: age is rounded to the nearest month

b. Items to be copied are presented one at a time to the child. The child's answer sheet has the template to be reproduced above a blank box. The child copies the the template in that box.

c. Explain to the child that some of these forms are hard for adults to copy (a true statement!)

d. The paper should be centered on the child's midline and NOT moved or tilted.

e. Erasures or corrections are not permitted.

f. A ceiling is reached when the child fails to score any points on three consecutive drawings or draws all figures assigned to their age.

g. A child through the age of 8 should complete figures 1-18 ONLY

h. Older children may complete the entire booklet, unless a ceiling level has been reached. 

2. Scoring:

a. Items passed are worth a variety of point values depending on the difficulty of the drawing (worth 1-4 points). a cumulation of points gives a raw score.

b. Normative data (4-17 years) is presented for every three month period!

c. Raw scores are looked up for the particular age and a scaled score is found in Table 4.

d. The percentile in a normal population which the raw score falls is also found in Table 4 as well 

B. Detroit Visual -Motor Ability and Speed Sub-test: tests eye-hand coordination skills.

1. Administration: the child is presented with a sheet having many circles of various sizes and asked to place a mark like this "X" inside each circle as rapidly as possible

a. the child does this for a varying amount of time depending on age:

i. two minutes: through 5th grade (ages 5-10)

ii. three minutes: grades 6-7

iii. four minutes: ³ grade 8

b. the child completes a practice row (at top) before attempting the test

2. Scoring: two scoring categories are set up and normalized from ages 4-6 through 15

a. precision and speed score: a point is assigned for every circle with a well formed "X" within it (not exceeding the border)

b. speed score: one point is assigned for all circles attempted in the time period

c. find the age of the child in the left column of the normalization chart

d. look at the expected for the particular age and elapsed time of the test

e. find the corresponding age for the child's score (if different)

*NOTE: The Wold Visual-Motor Test is another timed test for eye-hand coordination skills in which the child connects vertically oriented dots and then horizontally oriented dots. Scores are tabulated for each group and compared to norms. This test, however, is not well known outside of the optometric profession.