I. Introduction: the tests described in this handout rely less on standardized administration and scoring of the test (although there are rules to follow!) and more on observing:

1) The child's general behavior :

- are there poor attention skills

-does the child appear hyperactive

- is there motor support or overflow when attempting a task

2) 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?

The ability to observe these behaviors and record them are very important to any perceptual evaluation. Most of the time you gain the most insight from watching a child attempt to write, draw or complete a puzzle. These observations "guide you" to a proper standardized test sequence. It should also be noted that most of these tests have norms established, but they are not as detailed (ie normalized to every three month period) as standardized tests tend to be. In addition, the rules of the test are a bit less detailed than for standardized tests.

Again, we use the same seven categories or areas of vision perceptual skills. The tests associated with each visual perceptual skill will be listed. It is important to note here that many tests evaluate more than one visual perceptual skill; dividing them into neat categories is impossible. Therefore, a single test can measure several perceptual skills "with one shot"

 

II. Specific Non-Standardized Tests for Visual Perceptual Skills: because these tests tend to measure several visual perceptual skills simultaneously, they will be described individually. The same seven visual perceptual skills, however, still apply here.

 A. The laterality tests: the Piaget Right Left Awareness Test , Money Road Map Test and the LRD Test.

1. The Piaget Right Left Awareness Test: this test is presented in five stages. The child must answer all six questions consistently in a particular level before proceeding to the next stage of testing.
a. identification of left and right body parts (6) of the child: must get all six correct to "pass" this stage. It is called Stage I.
i. correct identification indicates proper internal lateralization skills.

ii. consistent reversed labels may be indicative of having the cognitive ability to make L/R discrimination, but a poor labeling system

iii. the expected age for mastery of this level is 5 - 6 years old

b. identification of left and right body parts (6) on the doctor (who is facing the patient): must get all six correct to pass this stage.

i. if a child answered all the questions backwards at this level, he is reflecting his body schema to other objects and therefore has not yet achieved directionality skills

ii. consistent reversed labels at level one AND two (consistently) may be indicative of having the cognitive ability to make L/R discrimination, but a poor labeling system

iii. the expected age for mastery of this level is 7.5 - 8 years old

c. identification of the relations of two objects on a table. The child is answer

i. if object A is to the left or right of object B

ii. if object B is to the left or right of object A

iii. the child then walks around to the other side of the table and repeats the procedure

iv. the expected age for mastery of this level is 7 years old

d. identification of the relationship of two objects on the examiner's body (ie. a watch and a coin)

i. is the coin to the L/R of the watch

ii. is the watch to the L/R of the coin

iii. the expected age for mastery of this level is 8 years old

e. identification of three objects in relation to each other (key, pencil and a coin)

i. ask all six possible combinations of directionality questions

ii. the most significant difficulty arises from the middle object

iii. the expected age for mastery of this level is 10.5 - 11 years old

2. The Money Road Map Test: a rather difficult task for most children is following a map. It requires well developed visualization skills as well as laterality/ directionality skills. In this test, the child is to report to the doctor when he/she must turn left or right to stay on the designated printed path.

a. it has established norms, but it is most valuable as a tool to observe the child's problem solving behaviors

b. it is an excellent therapy device, so I rarely use it to test a child's laterality/directionality skills

3. The LRD (Lorraine R. Davis) Test: useful clinical tool to determine those children with incomplete laterality/directionality skills. It is a good clinical tool, but there are no established norms for it.

a. a single piece of paper with a vertical line running through it is aligned to the child's midline

b. the child is asked to reproduce the alphabet (in CAPITAL LETTERS), alternating the letters on each side of the vertical line

c. a child with poor laterality skills may have memorized the alphabet as a "chain"; the forced alternation breaks the chain

B. The tests for form recognition/bimanual integration/visuomotor hierarchy: the circus puzzle, the form and split form puzzles and the slotted puzzle

1.The Circus Puzzle: an old optometric test that still has clinical usefulness. It consists of a seven pieces with a circus theme
a. the child is seated and views the completed puzzle

b. the pieces are removed and placed on the table opposite to the side of their proper position

c. the child is informed to try to put the puzzle together. The effort is timed.

d. watch for impulsive/reflective behavior

e. FORM MATCHING: the doctor observes how the child is able to visualize how the piece should be oriented and which space the piece should go.

i. does the child choose the appropriate space for the piece

ii. does the child try to force an inappropriate piece in a space and NOT correct : form error

iii. does the child place the piece inappropriately, but then correct: false start

iv. from errors should be eliminated by 6 - 6.5 years old.

f. Visual MOTOR HIERARCHY (VMH): how well does the child visually inspect his/her environment.

i. does the child choose the proper site for the piece originally, visually inspecting the space and rotating the piece into its proper orientation before placing it (high VMH)

ii. does the child try to force the piece and then "feel" for the correct orientation (low VMH)

iii. does the child orient the pieces properly before touching the board and require little to no "feeling" for the proper orientation of the piece (high VMH)

iv. good visual inspection skills are expected by the age of 6.5

g. BIMANUAL INTEGRATION: how well the child has learned to use a dominant hand/support hand system for task completion

i. alternating unilaterality: (4 - 5 y.o.) child will use one hand pick a piece and place it at the total exclusion of the other hand. The child also has difficulty crossing the midline

ii. bilateral symmetry: (5 - 6 y.o.) the child will pick up pieces 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.

iii. bilateral asymmetry: (7 - 8 y.o.) the child acquires a lead hand and an actively supportive hand for the puzzle. 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.

2. The Form Puzzle/Split Form Puzzle: newer puzzles that have been more widely used in other professions than the Circus Puzzle.

a. a three and six piece edition of the form puzzle have been developed

b. a six shape split form puzzle (12 pieces) has been developed

c. the same rules and obsevations should be followed as were described for the circus puzzle

d. the split form puzzle is the most difficult, as it requires the best visualization skills and visual planning and organization

e. don't forget to observe the child's impulsive/reflective behavior

3. The Slotted Puzzle: a slightly different twist, as all the pieces are the same (a skeleton key shape). The trick is to orient them properly into the slotted spaces.

a. therefore, in addition to proper form recognition, the child must also have a certain directionality ability to consistently place the slot in the proper orientation

b. the same rules and obsevations should be followed as were described for the circus puzzle

  • c. normalization for time to complete the slotted puzzle has been published and is available in the clinic
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    C. Tests for form reproduction and visual motor integration:

    1. Winterhaven Copy Form Test.
    a. A total of seven figures are presented to the child. The child is told that he/she will have to draw the seven figures on a sheet of paper.

    b. Do not name the figures, as it may change the child's responses.

    c. Align a blank sheet of paper along the child's midline.

    d. The child then draws each figure EXACTLY AS THEY SEE IT as it is presented.

    e. The child should not be allowed to turn the paper to draw a diagonal line unless it is the only way he/she can complete the figure. Any attempts to turn the paper should be noted.

    f. ITEMS TO OBSERVE:

    i. posture and pencil grip: are they proper?
    - note head turns or tilts

    - note improper pencil grip; wrong hand orientation or too tight

    ii. bimanual integration:

    -. alternating unilaterality: (3 - 4 y.o.) the child may use either hand on attempted drawings

    -. bilateral symmetry: (5-6 y.o.) child will begin to understand the different roles for the hands. The use of the non-dominant hand for support has not been fully established yet.

    -. bilateral asymmetry: (³ 7 y.o.) the child acquires a lead hand and an actively supportive hand for each drawing. The child will cross the midline without difficulty and show a mastery over self-lateralization.

    iii. organization: how does the child anticipate the seven figures to be drawn on the page and how organized is the execution.

    - superimposition of the figures: expected from a 2-4 year old

    - random placement of the figures: expected from a 3-4 year old

    - central to peripheral organization: expected from a 4-5 year old

    - vertical or horizontal arrangement: should be complete by 7 y.o.

    iv. Form Construction: how the child draws the figures

    - homeomorphism: the child sees the shape as a different entity, but is unable to reproduce it. Therefore, the effort looks like a circle, even if the child intended to draw a square

    - "dog ears": the inability for the child to rapidly change directions when drawing a corner; it leaves a jagged corner.

    - the circle should be drawn correctly at the age of 2.5 - 3

    - the cross should be drawn correctly at the age of 3

    - the square should be drawn correctly at the age of 4

    - the triangle should be drawn correctly at the age of 5-6

    - the "British flag" pattern may be drawn with segmentation at ages of 6 -7

    - the "British flag" pattern should be drawn correctly at the age of 7

    - the diamond (not a square on it's side) should be drawn correctly at the age of 8

    v. Visual Motor Hierarchy: it is important to note the posture of the child as well as the amount of motor support and motor overflow required when attempting to draw

    - tilting of head/page

    - use of tongue (as motor support)

    2. The Test Of Visual Analysis Skills (TVAS): tests visual motor integration/form reproduction skills, visual closure skills and form discrimination skills

    a. Administration: the child is to start at the beginning of the test booklet no matter their age.
    i. On the left, a template is presented on a grid pattern.

    ii. The child is to copy the template on the blank grid appearing on the right hand side of the page. The drawing must match the original in size, shape and position to pass.

    iii. After the tenth item, dots on the blank grids are fewer in number (here is where the visual closure skills come into play) and the child must draw lines and cornersas if the dots were really there.

    iv. The child may not actually draw the dots in.

    v. Erasures are allowed, but the child's overall behavior (including erasures should be noted

    vi. A ceiling level is reached when the child misses two consecutive drawings.

    b. Scoring:

    i. Each item passed is worth 1 point

    ii. Total point scores are compared to age expecteds printed on the test booklet

    3. Wold Sentence Copy Test: tests a mixed bag of motor visual perceptual skills along with cognitive skills

    a. Administration:
    i. The child is asked to copy a sentence presented on the paper:

    Four men and a jolly boy came out of

    the black and pink house quickly to see

    the bright violet sun, but the sun was

    hidden behind a cloud

    ii.The child is to write the sentence carefully, but as fast as they can as it is a timed test

    iii. Observe the child;

    pencil grip posture

    sub-vocalization loses place

    copying style letter/word reversal

    iv. The child may print or use cursive.

    v Timing begins as the child starts to write.

    vi. Maximum time allowed is 3 minutes.

     

    b. Scoring:
    i. count the total number of letters copied per minute and compare to the normative data provided with the test