Nepsy II results - Theory of Mind test/score

[seriously]

Just got back the neuropsychologist results which were limited since our insurance footed the bill and medical necessity ruled the day. Most of it was not new info but her recommendations included some things that were not what we've heard before.

Has anyone else had this test done with their difficult child?

difficult child 2 scored in the 2 to 5% range on Theory of Mind.

Theory of mind is to be able to reflect on the contents of one’s own and other’s minds.

I'm trying to decide to what extent I agree with this score. It is clear that difficult child 2 has serious issues with taking another person's perspective and understanding his own thoughts and feelings. But I would not have said it was virtually non-existent. I'm going to talk to the psychiatric when she gets back from vacation about whether he could have pulled his punches and this score may be inaccurate.

 

[DammitJanet]

Honestly I have never even heard of theory of the mind until the last couple of weeks when some of you guys have posted about it. Is it some new hot thing going around?

 

[InsaneCdn]

Because there are multiple things going on with difficult child, its possible that one test score is affected by another issue.

For example... if depression is severe enough, it could affect how one would test on the whole perspective thing.

I don't think a test like this is "cast in stone'. More likely, it is a "snapshot", and it is then necessary to figure out why and what to do about it.

 

[DammitJanet]

I think this is a new way of saying something that people have known forever. I just dont get it being a whole new theory myself. And Im not too impressed with that test saying its the ONLY one to do something. I am never fond of Only's and Nevers. I dont like black and whites. I was always taught that with true and false tests that if a question asked if something never did X, or always did X, that was probably a good time to say False.

 

[Liahona]

I know with my kids and husband theory of mind is almost non-existent. One of my pet peeves is about lack of theory of mind. It is when I'm walking somewhere in the house trying to get things done. PCs would be able to realize 'oh, she is vacuuming I need to move' or 'I need to not walk right there now. I can go around.' Instead my kids walk right in front of the vacuum and stop. Then when I ask them to move they are surprised. They look lost because they don't know where to go. I have to tell them move, over there, (and point), now! This is just one example. This happens over and over, all day long, times 4.

 

[Liahona]

yes, its probably been there forever (or lack of it) but its nice to have a term for it. So, I can talk about it with others and they might know what I'm talking about.

 

[buddy]

Honestly I have never even heard of theory of the mind until the last couple of weeks when some of you guys have posted about it. Is it some new hot thing going around?

No, this has been around for a long long time, but maybe it is getting into mainstream articles and training more? When it comes to the test, the validity (does the test really capture whether the person has or doesn't have this skill) would be a big question for me. (Just a theory...) But maybe it is saying that statistically speaking, people who have autism, or other issues that affect this skill, will score at this level. Since no test can check on every kind of situation where one would actually need this skill, there is no way to really test fully whether someone can take another's perspective EVER....I have not given this test and haven't been on a team that uses it, I have been on evaluations where we do informal things to check this In trainings they can show clearly that it is a common symptom, but not an "always" symptom. And it can really depend on how abstract the situation is. Does the situation requires someone to interpret tone of voice, facial expression, have a good short term memory, etc...

So I am only saying that this is a theory I would have as to what the score might be low if you feel that your difficult child has this skill at a higher level, but not really reflect his ability. It might just say that there is evidence that there is a problem with this skill on some level and it can support whatever diagnosis they are looking at.

just checked online: This is a subtest in a domain from a test that has 6 domains. So, there is only likely several questions to check this. The overall purpose of the test states that this test along with observations in class/home and information from other testing can give information that helps differentiate between different diagnoses. The specific subtest says: (hope it shows up because I cut and pasted it and the font size wont change here when I select it...maybe when I post it it will grow...)

Theory of Mind TM 3–16
This subtest is designed to assess the ability to understand mental functions such as belief, intention, deception,
emotion, imagination, and pretending, as well as the ability to understand that others have their own thoughts, ideas,
and feelings that may be different from one’s own and the ability to understand how emotion relates to social context
and to recognize the appropriate affect given various social contexts. In the Verbal task, the child is read various
scenarios or shown pictures and is then asked questions that require knowledge of another individual’s point of view
to answer correctly. In the Contextual task, the child is shown a picture depicting a social context and asked to select a
photograph from four options that depicts the appropriate affect of one of the people in the picture

First, that is a heck of alot to get out of a subtest of a subtest, smile. It looks like a really interesting test and like it can give some good differential information to help sort through the options for a diagnosis or to help identify areas of struggle. But given the description, if one had a hard time with reading facial expressions only, this would lower the score, if one had trouble with inferences, they would have a lower score, etc. It is an artificial way to test for this skill. It really can only give a clue that this might be an issue and then when put into the big picture of how a child functions in the real world, it could support or refute options for the diagnosis. That is how I see it, anyone else might see it differently. We always say when we test someone, remember....even if the test is a very good one the truth is this is how they did on THIS day under these circumstances. It is only a piece of the puzzle.

Sorry if this was overboard, but you made me wonder too, thanks for the education, smile.......bottom line, I wouldn't worry about a subtest score, how he does in real life is what to focus on and to encourage further development as much as possible. Just MHO​

 

[keista]

difficult child 2 scored in the 2 to 5% range on Theory of Mind.

If this is a percentile rank, it does not necessarily translate into "non-existent" When dealing with percentages of ppl, there can be a large disparity between % rank and actual ability.

 

[buddy]

If this is a percentile rank, it does not necessarily translate into "non-existent" When dealing with percentages of ppl, there can be a large disparity between % rank and actual ability.

I agree, good point Keista. On norm referenced tests they give percentile rank (not percentage correct) which means at the 5th percentile he is not at 2 SD below the average (mean) score. I hate statistics, but in the end, it is a subtest of a subtest...so...as I said I [personally would just use it as a clue that this may be a relative weakness, not that the skill does not exist. Just MHO, I dont get excited about standardized tests, they are useful for getting a diagnosis and getting service and help gude medication decisions if needed. They can give clues to strengths and weaknesses, help differentiate one disorder from another, and after that, the most important information is how the kid is doing in real life, home, school, etc.

 

[DammitJanet]

I also went and sat thru that stupid tests entire push for sales...lol. For a kid your sons age, and he is almost too old to take it since 16 is the upper end, they score it in percentiles. With 3 to 7 year olds, they score it in actual points made. I think that is a difference.

They give a kid a picture of kids and ask them if the kids are feeling the same things. Heck, watching that that thang, I couldnt remember from one page to another what one kid looked like! And trust me, I am empathetic. I think that is what this what they are looking for, the ability to feel empathy and put yourself in someone else's shoes. I dont think it has a thing to do with mind.

 

[seriously]

Thanks for the input folks. I have done some more research on this subtest of the NEPSY II focused more on interpretation of that score. Thanks buddy for suggesting a 2% score is not all that low - that sent me in the right direction. I am looking forward to talking with the psychiatric about the results. She's on vacation for the next 2 weeks so I will have to wait - not my strong suit.

On this particular test the standard deviation does not apply which is why it is reported as a %. The test results have a skewed distribution and this level of result is considered (according to the info I found) significantly below normal although your observation that this doesn't mean zero is almost certainly correct.

But I also found info that says that ToM has floor effects. A floor effect means that you can't score lower than a certain amount. If this score represents the lowest you can score then I think you can't really say anything more than that it's a much lower score than expected.

The NEPSY II "subtests" are designed to stand independently and can be used in cross-battery assessment or a tailored assessment using any combination of subtests. So ToM is not a subtest of a subtest. And the NEPSY II is specifically intended to identify clinically significant deficits and has ceiling effects in many subtests for that reason. Once a child reaches expected or above expected levels on an assessment, for the purposes of the neuropsychologist, the results are not important.

Thanks everyone. I'll pass on the psychiatric's info when I talk to her.

 

[confuzzled]

ToM is sometimes a flag when looking for spectrum diagnosis's. in my opinion, whether there is ToM or not, it cant be the only criteria to make a diagnosis...all tests, scores and hx need to be considered (and interpreted properly) to point in that direction.

and all of it is still only a guide--afaik, there is no battery of tests to date that can conclusively diagnosis Autism Spectrum Disorders (ASD)'s--its only one piece of a puzzle to lead to that conclusion.

 

[buddy]

Great, hope you can just relax about it in the mean time. (Oh, by subtest of a subtest, I simply meant that any test with all of those questions usually are not as comprehensive in terms of the amount of items offered....so even if there are 20 items it is not the same a a full protocol designed to only look at that one thing). It still seems to me that you already know that this is an issue and all the test showed is you are probably right. So many factors can influence a test where they have to look at facial expressions and judge....the language is different, they are pictures, not real breathing faces that move, etc. I bet your gut is right he does have some insight. Just a relative weakness, which is good to know. I hope you share what they say because it is really interesting to learn about it.