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!). Both standardized and non-standardized tests are available to test a variety of visual perceptual skills. Both have inherent advantages and disadvantages that are discussed below.

 

A. Standardized tests:

1. The advantages of standardized testing are obvious:
a. a nation wide pool to compare your patient's score.

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

c. avoidance of personal (and professional) bias from entering into your evaluation of the patient.

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

a. 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).

b. 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.

B. Non-standardized tests: rely less on rules and regulations and more on observing the child's general behavior as well as the method the child used to arrive at a particular answer The product and the process are emphasized.

- is posture and pencil grip appropriate for age?

- is bimanual integration appropriate for age?

- is the child reflective or impulsive with responses to questions?

-is body knowledge and control appropriate for age?

-is the child showing normal visual-motor hierarchy development?

1. Advantages of non-standard testing, then, include the ability to observe these behaviors and record them. Most of the time you gain the most insight from watching a child attempt to write, draw or complete a puzzle.

  • 2. Unfortunately, these tests are unable to isolate specific visual perceptual skills as effectively as standardized tests. It requires a more skilled observer to make a correct (and specific) diagnosis.
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    C. At this point, it may be advantageous to introduce several new terms to our visual perceptual vocabulary.

    1. Impulsive behavior: the responses from the child are rapid and any attempts to understand or complete the task are minimal. This child "wants to get the testing over with".

    2. Reflective behavior: the child carefully plans their responses. Their attempts to understand or complete the task are whole hearted.

  • 3. Visual-motor hierarchy: the gradual development of a child's ability to visually inspect objects without touching them has been previously discussed. As the skills of visual inspection increase, the child should be able to accurately reproduce the visual stimulus without changes in paper tilt or posture. Motor overflow and motor support should also be minimized. Eventually, the child should be able manipulate the visual stimulus mentally (i.e. rotate or invert it ).

    4. Gross motor skills and body knowledge: the ability to use various large muscle groups in a coordinated, smooth action. Included in this category are balance skills and body awareness along with the obvious gross motor landmarks (creeping, crawling, standing, walking, running, hopping and skipping).

    5. Fine motor skills: the ability to produce and sustain smooth, coordinated movement with small muscle groups. Included in this category are oculomotility, reading, writing and drawing fine detail.

    6. Bilateral integration: a developmental sequence in which the child becomes aware of the symmetry of their body. It is an important step in a child's achieving self-laterality. It includes knowledge of(in order of appearance):

    a. up from down

    b. front from back

    c. left from right

    7. Bimanual integration: this, too is a developmental sequence in which the child acquires a particular pattern of hand (or foot) dominance. It is a subset of bilateral integration which involves much more than fine motor development. The child must also reach a point where they are self lateralized (i.e. have the ability consistently use one side of the body to execute a task and use the other side of the body as active support. Three stages of handedness have been described.

    a. alternating unilaterality: (< 5 y.o.) child will use one hand to complete task at total exclusion of the other hand. The child would show the same pattern with the other hand if asked to "draw with the other hand".

    b. bilateral symmetry: (5-6 y.o.) child will begin to understand the different roles for the hands. They will pick up items with the hand closest to the object and transfer it to the other hand (or held in both hands) if it is necessary to cross the midline. The child still does not cross the midline easily.

    c. bilateral asymmetry: (³ 7 y.o.) the child acquires a lead hand and an actively supportive hand for a particular task. The child will cross the midline without difficulty and show a mastery over self-lateralization. Although the child will consistently use a dominant hand for a particular task, it may not be the dominant hand for all tasks.

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    C. Specialists have identified many categories or areas of VISUAL PERCEPTUAL SKILLS. The following is a list of several key vision perceptual skills that may play an important role in learning in the classroom. They are in no particular order.

    1. Laterality and directionality:
    a. Laterality refers to an egocentric knowledge of the two sides of the body. In a young, school age child, this would include placing the "labels" of left and right when referring to a direction in relation to the child.
    i. this has implications in language (at least English) as well, because letter construction requires laterality discrimination

    ii. consistent laterality skills are required in order to avoid letter (b, d, p, q) confusion.

    b. Directionality refers to an object centered knowledge of position (ie. the child projects laterality into space (...the final frontier)). In a young, school age child, this would include placing the "labels" of left and right when referring to a direction in relation to another object (or person).

    c. Problems associated with D/L problems include:

    i. left/right confusion

    ii. reversal of letters

    iii. inconsistent hand preference

    d. Tests for D/L evaluation:

    i. Jordan Reversal Test

    ii. Reversal Frequency Test (Gardner)

    iii. Test of Lateral Awareness and Directionality (LAD)

    iv. Test of Pictures/Forms/Letters/Numbers/Spatial Orientation and Sequencing Skills

    v. Piaget Left /Right Awareness Test

    vi. LRD Test

    2. Form Perception/Discrimination: these skills not only require a proper input of visual information, but also an ability to process the visual information with some organization.

    a. Problems associated with form perception/discrimination may include:
    i. not able to discriminate details

    ii. confusion of similar words or forms

    iii. makes frequent copying errors (this is also associated with visual motor integration skills discussed later)

    iv. does not self correct

    b. Tests for form perception/discrimination evaluation

    i. Test of Visual Perceptual Skills (Non-Motor) (TVPS): Visual Discrimination, Visual Spatial Relationship, Visual Form Constancy sub-tests

    ii. Motor-Free Visual Perceptual Test (MVPT)

    iii. Frostig Developmental Test

    iv. circus puzzle/split form puzzle/slotted puzzle

    3. Visual Closure: the ability to "complete" a figure from the incomplete information (visual) given.

    a. Problems associated with visual closure may include:
    i. poor anticipation of visual events

    ii. inaccurate initial impressions

    b. Standardized tests for visual closure evaluation

    i. Test of Visual Perceptual Skills (Non-Motor) (TVPS): Visual closure sub-test

    ii. Motor-Free Visual Perceptual Test (MVPT)

    iii. Illinois Test of Psycho-linguistic Abilities Sub-test

    4. Visual figure ground: this skill is the one used when completing one of those nifty "Seek and Find" puzzles in Highlights. Unfortunately, Highlights is not standardized. The primary skill is to select the important visual object in spite of a lot of visual "noise" in the background.

    a. Problems associated with visual figure ground may include:
    i. easily distracted

    ii. may skip problems

    iii. may "lose forest for the trees"

    b. Tests for visual figure ground evaluation

    i. Test of Visual Perceptual Skills (Non-Motor) (TVPS): Visual Figure Ground Sub-test

    ii. Motor-Free Visual Perceptual Test (MVPT)

    iii. Frostig Developmental Test

    5. Visual imagery/visualization/ visual memory/visual sequential memory/ visual recall: these terms are NOT synonyms, but rather, a continuum of skills required for proper processing and memory of visual images.

    -Visual imagery is considered the backbone of all visual memory skills: an ability to a mental picture a visual stimulus accurately

    - Visualization is at least a vertebrae of the backbone! It involves the ability to manipulate or rotate that visual image. It also involves the ability to "see something in your mind " from symbols or other sensory cues.

    - Visual memory is the ability to recall a foreign visual stimulus that was rapidly presented and select the correct response when it is shown again

    -Visual sequential memory is the ability to remember a chain of these foreign symbols in the order presented

    -Visual recall, the most cognitively demanding skill, involves recreating a foreign visual image presented for a few seconds FROM SCRATCH! The Monroe Visual III visual memory test evaluates visual recall skills. It is hard!

    a. Problems associated with visual imagery et al. may include:
    i. reduced comprehension

    ii. poor recall of visual information

    iii. reduced sight vocabulary

    b. Tests for visual imagery et al. evaluation

    i. Test of Visual Perceptual Skills (Non-Motor) (TVPS): Visual Memory and Visual Sequential Memory Sub-tests

    ii. Motor-Free Visual Perceptual Test (MVPT)

    iii. Visual Auditory Digit Span (VADS)

    iv. Monroe Visual III Test

    6. Visual motor integration(form reproduction): The major problem here is reproducing an visual stimulus. It requires organization and some eye- hand coordination and fine motor control, but the emphasis is placed on cognitive and analytical skills. It is very important to watch the process when testing these skills

    a. Problems associated with visual motor integration may include:
    i. unable to reproduce difficult forms

    ii. poor penmanship and organizational skills

    iii. RECOGNITION OF ERRORS BUT UNABLE TO CORRECT THEM

    b. Tests for visual motor integration evaluation:

    i. Beery Test of Visual Motor Integration (VMI)

    ii. Bender Gestalt Drawing Test

    iii. Winterhaven Copy Form Test

    7. Eye hand coordination: this skill places emphasis on the ability to coordinate a fine motor response to visual stimuli

    a. Problems associated with eye hand coordination may include:
    i. poor penmanship and organizational skills

    ii. difficulty staying on the line when writing

    iii. recognition of errors but unable to correct them

    iv. ROTATES PAPER OR CHANGES POSTURE AND HAS A POOR PENCIL GRIP WHEN WRITING OR DRAWING

    b. Standardized tests for eye hand coordination evaluation:

    i. Detroit Visual -Motor Ability and Speed Sub-test

    ii. Wold Visual-Motor Test