• What a standard score misses
• What an OT measures — and what we do not
• Why performance-based measurement holds up

• Norm-referenced perceptual batteries answer a psychometric question; the referral usually asks a performance question. Both are legitimate. They are not interchangeable.
• Standardized perceptual batteries systematically under-sample the oculomotor and near-point efficiency floor, which is why "visual perception WNL" so often coexists with a real Level 2 limiter.
• The VPA™ trades the normative standard score for level-and-domain specificity that maps directly to intervention. Name that trade in your report before anyone else does.
• Criterion-referenced results cannot establish an eligibility category. When a normative comparison is required, administer a norm-referenced instrument or refer.

A school psychologist tells you, "The perceptual testing came back average, so we can rule vision out." Write a two-sentence reply that names what the battery sampled, what it did not sample, and what you propose to do about it, without disparaging the instrument or the colleague.

Write, in one sentence, the difference between "this student is at the 16th percentile for visual perception" and "this student loses the line during sustained silent reading after four minutes." Which sentence writes an accommodation?

Pull the last visual-perceptual report you wrote. Highlight every sentence that describes a score and every sentence that describes performance during an occupation. If the score sentences outnumber the performance sentences, you have found your revision target.

• Why 15 skills across 5 domains
• When to reach for a standardized tool

• 15 skills across 5 domains; the domain says what is measured, the level says how hard the item is. The output is a profile, not a global score.
• Fast Screener = triage yes/no. Mini VPA™ = which domains need full assessment. Full VPA™ = the profile that drives the plan of care.
• Age-band content variants exist to protect engagement, which protects measurement. Never hand an adolescent a primary-grade stimulus.
• Interactive and printed administration are item-equivalent, but never mix modes inside one skill, and always record the mode used.
• Observation data (head movement, refixations, latency, discomfort) is part of the finding, not optional color.

A student is described by two teachers as losing stamina in the second half of any reading block. He flags on the Mini VPA™ in Domain 2 only, with all other domains at criterion. What is your next step, and what would you have done differently if Domain 1 had also flagged?

In one sentence each, state the job of the Fast Screener, the Mini VPA™, and the Full VPA™. If any two sentences sound alike, you have not yet separated triage from routing from assessment.

Sketch the 5 × 15 grid, domains down, skills across, from memory, then check it against the VPA™ scope page. The gaps you find are the domains you are least likely to assess in practice.

• Non-negotiables before the first item
• Why stimuli change with the band
• Eye dominance: Porta and Miles tests
• Below the floor of the VPA™

• Setup is the measurement condition. Age band, distance, lighting, and positioning are part of the instrument, not preliminaries.
• Chronological age selects the band by default; language or reading access can justify selecting down, advanced material can justify selecting up, record the substitution and the reason either way.
• Intermediate (60 cm) and near (40 cm) are separate measurements with distance-matched card sizes. Never substitute one card set for the other distance.
• Band-adaptation is real and partial: language- and print-loaded tasks (saccade columns, reading passages, writing prompts, discrimination sets, fixation load, all Functional Integration scripts) swap by band; geometric tasks (form constancy, closure, spatial, memory, VMI figures) are held constant by design.
• Postural instability recruits head movement into oculomotor tasks and produces false efficiency deficits. Stabilize the base or flag it.
• Complete the intake before the first stimulus, lens status and date of last eye exam change Domain 1 interpretation before you measure anything.

A 12-year-old with a documented reading level of mid-first grade is referred for copy difficulty. Which age band do you administer, what do you record about the choice, and which single domain is most at risk of being misinterpreted if you get this wrong?

Name the two VPA™ working distances and the occupation each one represents. Then name what happens to interpretability if you present a near-sized card at the intermediate distance.

Measure your usual testing setup with a tape: chair-to-table height, the distance at which you actually hold a near card, and the illumination at the task surface. Write the numbers down and correct anything more than 5 cm off.

• Script discipline
• What triggers a Full VPA™
• Near point of convergence — the penlight probe
• What to watch while they work

• Five probes, one per level, fifteen to twenty minutes. The Mini VPA™ routes; it does not describe.
• Occlude with a card, never a palm. Measure NPC with three trials and record break and recovery separately, fatigue across trials is a finding.
• Time the visual memory exposure with a timer. A drifting interval turns a memory task into a discrimination task.
• The VMI copy task leaves the model visible; record process (grasp, stabilization, model rechecks) alongside product.
• Say the script, then stop talking. One standard re-instruction maximum, and record that you gave it.

During Probe 2, the student never reports doubling, but you observe the left eye drift outward at 12 cm and return at 18 cm. What do you record, and what do you write in the report, and what do you deliberately not write?

Without looking, name the five Mini probes in order and the level each one samples. Then name the one probe where you are most likely to talk too much.

Administer the Mini VPA™ to a colleague or family member this week while running the 20-item administration-fidelity checklist on yourself. Score honestly; the items you miss are the items you will miss with a student.

• Progression, basal, ceiling
• The five validity threats
• The 15 skills sit on the five levels
• Keeping a full battery clean

• Full VPA™ progression is strictly sequential from Level 1. Adaptive entry inflates profiles and hides the floor.
• Basal = criterion performance at the first level administered. A Level 1 failure stops that skill; a Level 1 Domain 1 failure triggers referral immediately.
• Ceiling = the first level failed; achieved level = highest level passed. Never score an unreached ceiling as a Level 5 pass.
• Five validity threats: incomplete basal/ceiling, environmental deviation, fatigue, attention/behavioral state, unfamiliar stimulus content.
• Domain 5 is administered last and is the most endurance-loaded, suspect fatigue there first, and re-administer fresh rather than interpreting through it.

A student was referred because she cannot locate the problem she is working on in a dense math worksheet. She passes Levels 1–3 in figure-ground, fails Level 4 narrowly after a hallway interruption, and you stop. What is the achieved level, what do you flag, and what one additional trial would you consider?

Write the basal rule and the ceiling rule in one sentence each, then write the sentence you would put in a report when the ceiling was never reached.

Review your last three evaluation reports for any statement that would have required an unreached ceiling to support it. Rewrite one of them to state what was actually administered.

• Read the shape before the numbers
• What the report may and may not say
• When a standardized chart adds value
• Turning the profile into a plan of care

• Interpret bottom-up: an unstable lower domain makes every higher-domain finding provisional. Say that explicitly in the report.
• Read profile shape, not single-skill depth. Flat low = suspect a global factor or invalid administration; bottom-heavy = the efficiency pattern; top-heavy = processing vs. visual-motor, and the distinction drives the plan.
• A flag earns a disposition, further assessment, intervention, or referral, not a conclusion.
• Every finding ends in an occupational performance statement: occupation + limiting visual factor + observable impact.
• Use criterion language ("below the Level 3 criterion for the 8–11 band"), never normative language ("below average"), for VPA™ results.

A 9-year-old is failing to complete written assignments and stops reading after roughly five minutes. His profile shows Domain 1 intact, Domain 2 achieved Level 2, Domain 3 achieved Level 4, Domain 4 achieved Level 4, Domain 5 achieved Level 2. Name the profile shape, the most likely limiter, and the one sentence you would put in the present-levels section.

Rewrite this sentence so it is criterion-referenced and occupation-linked: "Student demonstrates below-average visual motor integration skills."

Take one completed protocol and write three occupational performance statements from it, each containing all three rubric elements. Then delete every sentence in your draft report that has none of them.

• The same four questions in every case

• The referral word is a hypothesis, not a finding. In all three cases it pointed away from the actual limiter.
• Time course discriminates efficiency from processing: efficiency degrades over minutes, processing is impaired from the first item.
• Intact discrimination and form constancy argue against a perceptual explanation for reversals; look lower or elsewhere.
• Repeated model-rechecking with intact Domain 3 is the behavioral signature of a Domain 4 production limiter.
• Referral and OT intervention proceed in parallel, neither waits for the other.

Re-read Case B. Write the two-sentence explanation you would give the classroom teacher for why "he can do it when he tries" is consistent with the finding rather than evidence against it.

For each of the three cases, name the domain that carried the finding and the domain the referral word pointed to. Note how often they differed.

Pick one student on your caseload whose referral concern you have accepted at face value. Re-read their data and ask which domain the evidence actually implicates.

• A defensible VPA™ report
• Referral decision rules
• How the profile actually defines the intervention
• From achieved level to an IEP-ready goal
• Three rules that keep the activity honest

• Three dispositions: refer for medical eye care, proceed to deeper assessment (Full VPA™ or a norm-referenced instrument), or proceed to occupation-based intervention. Referral and intervention routinely run in parallel.
• Refer on: Domain 1 below criterion, two-line interocular difference, pain/diplopia/headache with near work, observed strabismus or nystagmus, receding NPC, or no eye exam on record.
• Documentation needs four elements: named occupation, observable current performance, criterion-referenced visual factor, and participation impact.
• Never write "vision therapy," a lens/prism/filter recommendation, or a binocular diagnosis as your own finding. The practice does not shrink; the vocabulary changes.
• Retain the protocol, observations, validity flags, mode, band, and any deviations, a report nobody can reconstruct is a file defect.
• The entry point names the activity: L1 access/contrast changes, L2 pursuit-saccade-convergence work under the endurance ceiling, L3 perceptual work carried onto a real page, L4 graded visual-motor plus output accommodation, L5 treated inside the occupation. All named activities live in the Vision Library.
• Grading rules: treat at the lowest unstable level but measure at Level 5, change one variable at a time, and embed before you drill.
• Building the full plan of care from the profile is Course 3, Intervention Planning Using the Five-Level Framework.

Write a complete IEP present-levels statement from Case B in Module 7. Include all four documentation elements and no out-of-scope language. Then read it back and delete any word an OT licensure board would question.

List the referral triggers from memory. Then check the list. Any trigger you forgot is a student you would have kept instead of referred.

Draft your standing referral letter template for eye care, the one you will reuse, with a blank slot for the specific functional observations. Having it written before you need it is the difference between referring and meaning to refer.