By: Moira Creedon, Ph.D.
Pediatric Neuropsychologist, NESCA
Families often come to testing with questions like these: My child is so smart, why is reading so hard for them? If she can remember the smallest conversation from three years ago, why can’t she remember the two things I sent her upstairs to get? If he can do all of the calculations, why can’t my son solve a word problem? The answer can show itself in the scatter.
Assessment measures are based on statistical conversions, where the number of points a child or teen earns is “translated” into a scaled or standard score. This helps us to understand how your child performs compared to other children their same age. Tests are largely based on the idea that scores should “hang together” – meaning that if your child is average for his or her age on one task (e.g., visual-spatial skills) then they should be average on another (e.g., verbal knowledge). And while this may be true for many people, it certainly it not true for all people. Many people have “scatter,” meaning that there is a statistical difference between their scores.
I will spare you the controversy about scatter in our field, about whether a certain degree of scatter or difference between scores means that you cannot calculate certain other scores. There is also specific knowledge of scatter needed to diagnose specific learning disabilities (e.g., if your child has high average verbal skills, how far apart do their reading scores need to be in order to fit the diagnostic criteria). While those topics are incredibly important to the field, my focus today is to build a little empathy for how scatter can matter.
There are times when this scatter can lead us to a diagnostic decision. For example, a relatively common pattern that I see is that of a very bright teenager whose cognitive and problem-solving are at least above average, while their basic focus and attention is below average. With other evidence that corroborates it, this can mean ADHD. A big difference between a child’s verbal knowledge/language skills and their ability to use their language for social purposes can suggest an Autism Spectrum Disorder. In these instances, the scatter absolutely matters. But, scatter can be meaningful to a child’s daily experience even if it’s not statistically “big enough” to warrant diagnosis.
Imagine being your child for a moment. Perhaps your child has a knack for building complex Lego sets and can spend hours assembling structures that are intricate, detailed, and involve more small pieces that my adult fingers could tolerate (let alone our feet as we step on them!). Perhaps your child’s visual-spatial skills are incredible, scoring in the high average range compared to their friends. Then you place a book in their hands and ask them to read a page aloud, where they struggle to sound out words, track their eyes smoothly across the page, or understand the meaning of anything they are saying. While you are left scratching your head as a parent, imagine the frustration and disappointment your child must feel wondering: why can I work with Legos better than anyone I know, but decoding words is torture?
In my mind, scatter can mean frustration. To feel exceptionally strong and confident in one skill domain and then barely hang on in another can leave your child disappointed, angry, and self-critical. Imagine having a vocabulary and encyclopedia of facts in your mind and your hand simply cannot keep up with your thoughts as you try to take notes or write down ideas for an essay. For an adult, it can be a bit like sitting in front of your computer with too many browser windows open and programs running at once, slowing down the entire operating system to the point that you growl in frustration (anyone else?).
While it can be easy to get lost in the controversy over the technical and statistical nature of scatter, it is important that we all have some empathy for what this must feel like for your child or teen. Empathy for this experience is a critical part of building the roadmap forward: where we can use those strong skills to build up the weaker ones, to grow new and stronger neural connections, and to give ourselves a little grace and patience when those weaker muscles get challenged.
About the Author
Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.
If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form.
Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email firstname.lastname@example.org or call 617-658-9800.