Pilot Study on IQ of Children with Learning Disability and Normal Children Tested by Leiter International Performance Scale-Revised (Leiter-R)

Vanida Chaninyudthawong, M. Sc. (Clinical Psychology)* Prasert Chutha, M. Sc. (Community Medicine)**

Chantanee Mungketklang, M. Sc. (Clinical Psychology)*** Atjima Siripiboonpol, M. Ed. (Early Childhood Education)***

Thailand has been immensely affected by both negative and positive impacts of the global changes and civilization. The management of these challenges depends upon persons with effectiveness and abilities in the society. Therefore, the focus on personnel development is of great importance as individuals receive proper early intervention and stimulation could be developed to achieve their full potential. However, some groups of people that require special needs are deemed necessary for support at the early stages of their life.

There are many groups of children with special requirements, for instance, those who need specifically special care separately from normal children and those who live their life harmoniously with normal ones. One of the groups who are not necessary for separation from normal children but an urgent support is required, is children with learning disability^{1 (LD).They face difficulties in learning even though their IQ is normal or even higher than standard criteria compared to the children at the same age. This disability is not arisen from hearing, visual or intellectual problems or lacking educational opportunity. Symptoms are expressed through problems in reading, writing and calculating such as disabilities in literacy, spelling, reading comprehension or writing letters similar to mirror reflection, solving arithmetic problems and so on. They come with the only facet of problems or several facets altogether resulting in learning achievement lower than IQ. Currently, there are more children with learning disability found in Thailand.}

According to LD association of Thailand, it was indicated that 1 out of 10 of normal children possessed learning problems so that a special school was needed and almost half of them was LD. Of the informal but academic forecast, it was found that this group of children existed in the educational system in Thailand no less than 900,000 persons. And it would reach over 4 million people if adults with LD who were hidden, were included. In addition, there was 6-10% of students found LD and in boys rather than girls at the rate of 4:1 which was in accordance with the 2005 survey of the Office of Basic Education Commission. 113,465 students with LD were found or 47.58% of the total numbers of 238,479 students with disabilities. Besides, Suchinda Pongaksorn, Ph.d.3, 4 mentioned on the 2007 interview on the situation of LD in Thailand and how to prevent and deal with it that in 2007 the Office of Basic Education Commission evaluated students in 2,700 schools out of 30,000 schools nationwide with the screening tests of students with attention deficit hyperactivity disorder, learning disability and autism (KUS-SI Rating Scale : ADHD/ LD/Autism) developed by Daranee Uthairatanakij, Ph.D. of the Demonstration School of Kasetsart University and assistant professor Charnvit Pornnapadol, MD., the faculty of medicine, Siriraj Hospital, and found that over 130,000 students were LD and the Office of Basic Education Commission planned to cover all schools during 2009-2011. However, the past survey or discovery of children with LD were only the primary screening. Thus, the study of the standardized tests of clinical psychology was of great importance to be more properly optional tests and facilitate more accuracy and completeness of diagnosis.

Leiter International Performance Scale-Revised (Leiter-R), one of the IQ tests that could be merely used with children with LD, was applied in this study. However, there was no research of this tool in Thailand in order to prove its effectiveness in exploring learning disability in Thai children as it was done overseas. As the above test was for measuring ability not language ability, a few impacts was on cultural differences. Hence, it was assumed that it could screen children with LD in Thailand as well. Samples of children with LD in this study had the following problems; attention deficits, improper planning and organizing (mixed up process), visual-motor coordination problems, lacks of concrete or solving thinking, color, size and shape sorting problems, direction confusion, left and right (some left handed, some both), short and long term memory.7 Most of them were visual and attentive abilities that could be measured by Leiter-R test including reasoning, dimension, attention and visual-memory which were fundamental abilities of education directly affecting learning achievement of children. Consequently, Leiter-R test was one optional application in clinical research of the children with LD. This study then compared the IQ and the characteristics of the differences of their ability and normal children’s which was expected to be clear from the above tool in order to be a set of data useful for further developing the diagnostic standard of the IQ of children with LD including the convenience in exploring problems leading to potential method of treatments and education management relevant to their competence accordingly.

Materials and Methods

Descriptive Research was used in this study.

Populations comprised both male and female normal children and children with learning disability aged 6-11 years old studying in primary school level 1-6.

Samples were specifically selected from normal children in primary school level or Prathom 1-6 of Mae Phra Fatima school and/ or Piboonprachasan school and groups of 30 children with LD who received services or used to visit Rajanukul Institute or Yuwaprasart Waitayopathum Hospital.

Leiter International Performance Scale-Revised (Leiter-R) created and developed by Gale H. Roid and Lucy J. Miller5,6 was manipulated. The Visualization and Reasoning Battery (VR) set of tests was administered so as to investigate the mentioned IQ. The 10 sub-tests were included in this set of tests but only 6 of them were selected; Figure Ground (FG), Design Analogies (DA), Form Constancy (FC), Sequential Order (SO), Repeat Pattern (RP) and Paper Folding (PF). These sub-tests were to be able to calculate the Fluid Reasoning, Brief Scale IQ and Full Scale IQ. Samples in this study were 6-11 years of age which some subtests were used for samples with ages under 6 years old but not for calculating the Full Scale IQ so they were excluded.

1. All parties involved were contacted for requesting for permission to collect data as assigned.

2. Consent forms were dispatched to related parties to inform of research protocol and data collection.

3. Data were collected as per scheduled time (from 1 July 2010- February 2011) by research team trained on how to manipulate the test, how to collect data individually within 30-45 minutes. 4. Prepared the location and the test was individually proceeded according to the standards of clinical psychology and operation manual of IQ test of Leiter-R.

5. Clearly explained how to take the test to the samples and built a good tie before taking a test.

6. Checked the date of birth of the samples.

7. Checked the test and scoring.

8. Put score according to the criteria of IQ test of Leiter-R.

9. Analyzed data and summarized the result of the study.

1. Descriptive statistics was used to perform the distribution of frequency, mean, and standard deviation of data from common recording form.

2. Composite scores of Fluid reasoning, Brief IQ, Full IQ and Scale score of 6 subtests which were Figure Ground (FG), Design Analogies (DA), Form Constancy (FC), Sequential Order (SO), Repeat Pattern (RP), Paper Folding (PF), were then compared to calculate for statistical differences using Mann-Whitney U test.

The results of 60 samples divided into 2 groups of 30 persons each were as follows:

Part 1 General information of children with learning disability (LD children) and normal children

Table 1 Characteristics of children with LD and normal children

Level of IQ of the total subjects

                              Normal Children (30)   LD Children  (30)

Normal  IQ level                           15                              15

Above normal IQ level                    5                               3

Under normal IQ level                     0                              12

According to Table 1, it was found that normal children and children with LD had close averaged ages (mean =8.7 and 9.3 years, SD= 1.8 and 1.2 respectively). There were 2 times more male children with LD than normal children and 4 times of female less than normal female children. When considering only children with LD, it was found that 6 times more male than female and close proportion of male and female in normal children. There were equally 5 normal children from each class and most of children with LD were from Prathom 4 and P 3. No children with LD were from Prathom 1 but there were close numbers of children with LD from other classes. IQ level from standard FIQ of Leiter-R showed that normal children and children with LD were in normal level equally at 15 persons or half of normal children. Groups with IQ level higher than normal were among normal children of 5 times and none of them was lower than normal. But IQ level of 12 children with LD was lower than normal or almost half of them. Consequently, these differences affected the scores of each activity of the subtests. When results of the two groups were compared, the scores of children with LD were likely to have low scores evidently since the level of IQ on average was lower. Therefore, to avoid any bias and keep fair tests among the two, researchers then ignored those with IQ level higher and lower than average. Only children with normal IQ level (90-109) from both groups were calculated for differences between two groups.

Table 2 Characteristics of samples of children with LD and normal children with total IQ (Full Scale IQ) from Leiter-R tests in normal level.

According to Table 2, it was found that samples from normal children and children with LD had close average of age (mean= 8.9 and 9.3 years, SD=.50 and .25 respectively). There were 2 times of children with LD more than normal children and 9 times less than normal children in female. Considering only the group of children with LD there was 12 times of male more than female. Male and female of only normal children were in close proportion. The numbers of normal children were distributed in Prathom 1-6 with no more differences while the children with LD were explicitly in Prathom 3-4 more than in other classes. No children with LD were in Prathom 1.

Part 2 Hypothesis Testing

Table 3 demonstrated the scores of ability in the Visualization and Reasoning Battery (VR) in normal children and children with LD from Leiter-R among the group of total IQ (Full Scale IQ) in normal level.

According to Table 3, it was found that mean, standard deviation, the lowest and the highest composite scores, IQ of visualization (The Visualization and Reasoning Battery: VR) from Leiter-R in normal children and children with LD were normal of both Fluid reasoning, Brief IQ and Full IQ, and the standard deviation was similar in all.

Table 4 indicated the comparison of composite scores of ability in visualization (The Visualization and Reasoning: VR) obtained from Leiter-R between normal children and children with LD.

According to Table 4, the mean of the composite scores of the Visualization and Reasoning: (VR) obtained from Leiter-R consisting of Fluid Reasoning, Brief IQ and Full Scale IQ in normal children and children with LD showed no significant difference at .05.

Table 5 indicated the mean, the lowest and the highest composite scores of characteristics of each subtest acquired from the Visualization and Reasoning: (VR) of Leiter-R in normal children and children with LD.

According to Table 5, the means of both normal children and children with LD obtained from Leiter-R in the subtest of Form Completion (FC) had the highest score in normal level and Design Analogy (DA) had the lowest score which the mean of normal children was normal to fairly low while that of children with LD was lower than normal.

The mean of Figure Ground: FG and Folding Paper: FP of both groups was normal and identified close scores.

The mean of the subtest of Sequential Order: SO of both groups was normal which the mean of normal children was normal to rather high while that of children with LD was normal to fairly low. The mean of the subtest of Repeat Pattern: RP of both groups was normal.

Table 6 showed the comparison of characteristics of each subtest (Subtest Composite Score) obtained from the Visualization and Reasoning (VR) of Leiter-R in normal children and children with LD.

According to Table 6, it was found that scale score acquired from the Visualization and Reasoning (VR) of Leiter-R in normal children and children with LD from the subtest: Sequential Order (SO) had significant difference at .05 which children with LD had lower scores than normal children.

From the Hypothesis of the Study

1. The IQ of the Visualization and Reasoning Battery (VR) of Leiter-R between normal children and children with LD was significant.

Of the analysis, it was found that the full scale IQ fell on average, while fluid ability and brief IQ of both groups were not significant which was not in accordance with the hypothesis. However, it was conforming to the diagnostic criteria of children with LD in that they had difficulties in learning even they possessed the IQ level of normal or even higher than normal standard compared to children of the same age. In addition, no significance between both groups was found owing to a few samples.

2. Characteristics of subtest of Leiter-R between normal children and children with LD were different.

Of the Sequential Order (SO), normal children had the mean score at11.20 while children with LD had 8.73 which was significantly lower than that of normal children at .05. No previous study on this was found so it could not assume that the result of this study opposed or conformed to any others. However, these subtests measured the ability of pairing of visual stimuli perception regardless of memory aspects which could indicate the sharp ability of perception, ability of visual differentiation and awareness of the concordance of spatial relationships. The previous items of the test for the lowest age group were simple only matching colors or shapes and pictures with clear details. The latter items required more attention to details thanks to smaller sizes of pictures, less clarity that needed analytical skills of visual perception of pictures among the interference of other stimuli like figures, ordering pattern and linear position as well. The visual process, efforts and calmness to check the differences of the more and more complex stimuli were required.

Basic pattern of this pairing was used to measure receptive skills relating to general ability of the right hemisphere9,10,11. One of the learning disabilities found in children with LD was integration process8 which was the data interpretation process of received data as per personal experiences. The sequencing, abstraction and conceptual organization between old and new data were then decided.

In the case that children with LD had low scores of the subtest of Sequential Order (SO) would indicate the poor performance of organization (working confusion or no processes in work) which was in accordance with the general children with LD who had this problem compared to normal children. Apart from the subtest of Sequential Order (SO), the profile of scale score of both groups indicated that the lowest and the highest scores were from the same subtest. The scores were very close and were the same in other aspects. All of normal children had the scale scores of each subtest in normal level (10+2) of which the scale score of Form Completion (FC) was the highest and close at 11.27 while the lowest scale score was of Design Analogies (DA) at 8.80. Most of children with LD had the scale scores of each subtest in the normal level as well except for Design Analogies (DA) that had lower than normal at 7.40 while the subtest of Form Completion (FC) was the highest at 11.80. It was obvious that the mean scale score with the highest score of both groups came from the subtest of Form Completion (FC) which required reorganization of things or scattered parts. This required cognitive flexibility with the view of both sides- previous parts or later parts or partial parts or whole parts which were deductive process used for the differentiation of the ability to recognize and organize visualized components from the defects arising from spatial relationships of the subtest of Paper Folding (PF). This was dependent upon the consideration of things recognized and recalled including the ability to perceive overall image of unorganized parts. Even it was the measurement of ability of problem analysis and merely medium level of measurement for spatial relationships. It was also associated with structural thinking of holistic view of this subtest which required analytical thinking while the interference of visual ability of the subtest of Figure Ground (FG) required ability to distinguish other components by displaying that the ability of visual perception of both groups showed better scores with no difference. Design Analogies (DA) was the measurement of matrix reasoning that was widely studied in this subtest, comprising rationale items, seemed to be inferior to other aspects of ability. Items with/ without rationale required abstract spatial relationships, model, pattern and/ or the relationship of position that measured the ability of generalization of given data and determined inductive hypothesis whether which piece could form the complete picture. Pattern of the assigned matrix was the recognition of basic rules of hypothesis testing, relationship of stimulus discovery and effective response which were the indices of general ability in which both groups had close and low scores.

There were 3 subtests that both groups had close scores comprising figure ground (FG) -- a basic level of visual intervention similar to visual recall, repeated patterns (RP) -- an ability of reasoning without language focusing on building rules relating to the sequence of problems or data, a summary of the whole facts, and the subtest of paper folding (PF) -- an ability of deductive reasoning and sequence of ideas in the form of symbols.

This study could not identify the defects specific to children with LD, but only the observation in Leiter-R was found that the profile of scale score of children with LD and normal children had no explicit significance. Only the subtest of sequential order (SO) which children with LD had significantly lower scores than those of normal children. This study had not classified the specific group of children with LD, for instance, reading, writing or calculating. As a result, the limit of this study could not identify that these disabilities caused writing or mathematics problems of children with LD.

This study was the evaluation of the Visualization and Reasoning Battery (VR) between normal children and children with LD compared to the group of total score of IQ obtained from Leiter-R which could not generalize that the children with low scores in the subtest of sequential order (SO) were children with LD but the observation was that children with LD might have the disability in sequencing skills. However, the result of the test could be used for improving the skill of visual perception and reasoning related to their visual recognition and visual logical understanding as the more properly basic learning skills.

Recommendations for Further Study

1. Study in various groups and more samples should be made to set up norms for Thai children. This was only the pilot study so specific group of samples was selected.

2. The comparative study of the Leiter-R and other tests that the Visualization and Reasoning Battery (VR) or learning can be evaluated.

3. Other factors that may affect the visual recognition and reasoning of children should be investigated such as relating diseases.

4. The classification of children with LD should be done as to consider the scale score since completing the subtest required the ability of visual recognition and different reasoning which children with LD had not only one aspect of disabilities. They may have all aspects of problems altogether so the classification of the types of learning disability (reading, writing, mathematics, thinking process, etc) may affect the pattern of scale score of different subtests of each category.

Recommendations for the Application of the Test

1. Objectives and procedures should be explained to the children, their guardians and/ or responsible teachers that this study posed no harm to them and the data were collected for research purpose not for clinical diagnosis. Participation in the study had no impacts on regular tests of the school or normal treatment.

2. The willingness of children and their guardians should be considered as some children may receive permission from their guardians but they do not dare to join or some may be blamed or forced to participate. Talking with them helps reduce such pressure. Tests can be done whenever they are ready. For little children without attention while the tests are in progress, let them pause or stop and get them done the other day.

3. Operation Manual of the tests should be strictly followed.

4. The place of proceeding the tests should be quiet, no noise interference and a table equipped with efficient utensils; pencil, ruler, is appropriate for the subjects.