Interpreting an Occupational Therapy Evaluation

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I spend far too long writing up an evaluation, thankful for the moment it is off of my desk and into a parent’s hands. I’ve analyzed, interpreted, and poured my little OT heart into page after page. However, many times after a parent thumbs through the report, their first response is: “What does this all mean?”

I can’t help but feel as if I’ve failed the parents in these instances, because yes, they have every right to be confused. It’s a fine line that therapists travel in order to be parent friendly in our terminology, yet wanting/needing to sound technical in terms of insurance reimbursement (as well as simply forgetting that the terms we use every day aren’t so common to everyone else).

Not to mention that sometimes it just feels so right to throw in some fancy terminology to feel good about yourself as a therapist. (asymmetrical bilateral coordination…intrinsic activation…dynamic quadrupod grasp… Ok, I’ll stop. But I sounded smart for a minute there, right?)

One of the worst places for a parent to get lost in OT jargon is in the evaluation, especially when it comes to reporting standardized scores. The sad reality is that therapists get very little time budgeted for paperwork in general, so pumping numbers into tables and using large boilerplate explanations become second nature.

I’ve compiled some of the most common statistical terms you’ll see in an occupational therapy evaluation so that you might feel more comfortable interpreting the data. This is a very simplistic way of looking at these terms, so don’t set your sights too high in my statistical explanations.

First, allow me to pause for a moment to explain exactly what “standardized” means. When a test is standardized, it means that everyone everywhere administers and scores the test in the exact same way.

(So parents, if you are observing your child during testing, do NOT add any additional cues, even if you think your child should know the answer. Those additional prompts can void the standardization of the test and drive your therapist crazy.)

Most occupational therapy testing is also “norm-referenced”. This means that a huge sample of people were given the test as a means of comparison. So when I test your child, I can compare his results to those of other children his age, or the “normative sample”.

Many standardized test results are presented in a table format, such as the one I made up below. (Just an FYI, I totally made up all of these numbers, so they most likely make no actual sense; it’s just for explanation purposes.)

If your child recently had an occupational therapy evaluation, there should probably be at least one official table in the report, kind of like this one:

The Super Important Fine Motor Test- 3rd Edition

1.Raw Score 2. Standard Score 3. Scaled Score 4. Percentile 5. Age Equivalent
Sub-test #1 24 83 10 50% 5 years, 3 months
Sub-test #2 13 67 8 27% 3 years, 9 months

Here is a breakdown of each item in the table:

1. Raw Score: The raw score is the total number of test questions the child got correct, or the total points received on the test. The child might get one point for every shape they draw correctly on a visual motor test, or 2 points for every task they complete correctly in a fine motor test. The raw score data collection and total points possible are different for each test, so it doesn’t tell you much about how the child actually performed.

Side note about Raw Scores- typically a test will require you to stop collecting data after the child misses 3 tasks in a row, or something like that. This is called their “ceiling” on the test.

Some kids, especially older kids with autism, might have skills above this “ceiling”. Say I keep going with a test because I think the child made a few careless mistakes and I want to see what else they can do. If I find that they demonstrate skills above where I had to stop scoring, I might call these “scattered skills”.

For example, a report might say  “Johnny demonstrated visual motor skills around the 5 year, 3 month level, with scattered skills up to age 7”. (More about age equivalencies later.) This is just one of the frustrating parts about standardized testing for kids with special needs- it doesn’t always tell the whole story.

The following two statistics (scaled scores and standard scores) are a means of interpreting your child’s scores. They convert those raw scores into data that you can actually track and compare. Their jobs are to show you how far your child’s scores are from the average. (Remember that there is a range that is considered within average limits, meaning scores that are higher or lower than the average score that are still considered within the average range.)

2. Scaled Score: The average scaled score is typically 10, with a range of plus or minus 3.

3. Standard Score: The average standard score is 100, with a range of plus or minus 15.

(These numbers are common examples; double check the tables presented in your child’s report to assess how their statistics are reported in terms of the average ranges for scaled or standard scores.)

Scaled and standard scores are sometimes used to determine if a child “qualifies” for therapy. In some instances, a child won’t be eligible for services unless they score well below the average range. This can get tricky in some instances, because even though a child might have scored within average ranges, (i.e. a standard score of 85) their parent might be upset that their child is on the “low” end of average. One mother once told me she expected her child to always be on the high end of average, if not above average.

4. Percentile: This is how the child scored in relation to the entire normative sample. For example, in Sub-test #1, the child scored in the 50th percentile, meaning that he did better than 50% of the sample that participated in this test. (It also means that 50% of the sample did better than him. You know, that whole glass half full / half empty scenario.)

5. Age Equivalent: Oh goodness, age equivalencies- parents usually jump to this statistic because years and months make more sense than standard scores and percentiles. However, please don’t base your entire impression of your child’s skills on this number, because this “statistic” doesn’t hold much water.

The age equivalent is not an exact snapshot of the level of your child’s functioning. It is basically the average age of the normative sample that achieved the same score as your child on the test. Skills don’t develop in some exact sequential order. There are bursts of skill development throughout a child’s life. It’s not as if every month your child gains 2 skills- it just doesn’t work that way. Your standard and scaled scores are much better ways to “compare” your child to where they should be.

The bottom line is that therapists have to complete some form of testing in order to provide the most objective data on your child and track how they progress. However, it is also important to interpret the data and make sense of the numbers you come up with. All of this can quickly become confusing and open to debate when it comes to recommending or discontinuing therapy. Don’t be afraid to ask questions until you feel comfortable with the information presented to you.

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About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Insider Information, Occupational Therapy, Therapy Process and tagged , , , , , . Bookmark the permalink.

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