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

• Two tools, two jobs: the Classroom Screen decides whether to look; the Full VPA™ measures. Nothing sits between them.
• Classroom Screen: 30 observed behaviors, six per level, 3–5 minutes. Green 0–4, yellow 5–10, red 11+; automatic-trigger items escalate regardless of total; 3+ visual-motor items raise a handwriting flag.
• A screen result is referral history, never an assessment finding, and it produces no levels.
• Full VPA™: 12 skills across 5 domains, about 30 minutes, age-band entry with about three items per skill; acuity, contrast, saccades, and pursuits run from printed calibrated cards.
• The domain says what is measured, the level says how hard the item is. The output is a profile, not a global score.

Two teachers complete the Classroom Screen for the same 10-year-old. One scores him at 6 (yellow), the other at 12 (red), and only the second checked "complains that words move on the page." What do you do next, and how would you describe the two screens in your report?

In one sentence each, state the job of the Classroom Screen and the job of the Full VPA™. Then write the one sentence about a screen result that is allowed to appear in an evaluation report.

Without looking, list the twelve Full VPA™ skills under their five domains. Then check yourself against the skill menu. The skills you forgot are the ones you are least likely to observe carefully.

• 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.
• The acuity, contrast, and saccade cards are calibrated for a measured 40 cm and must be printed at 100 percent scale. The VPA™ does not measure distance acuity; board-copy complaints are observed in class and referred when no current eye exam is on record.
• 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 VPA™ working distance and the two print settings that keep the cards calibrated. Then name what happens to interpretability if you hold the near card at arm's length.

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 sends a student to the Full VPA™
• Near point of convergence — the penlight trials
• What to watch while they work

• Ask screen raters to check only behaviors seen in the past few weeks during ordinary work; record who completed it, when, and where. Disagreement between raters is information.
• Run the materials checklist before the student arrives. Print cards at 100 percent scale, matte, toner saving off, and check the calibration mark.
• Acuity, contrast, saccades, and pursuits run from printed cards at a measured 40 cm with habitual correction on.
• Occlude with a card, never a palm. Measure convergence over three trials and record break and recovery separately.
• Say the script, then stop talking. One standard re-instruction at most, and record it.

During the convergence trials, the student never reports doubling, but you see the left eye drift outward at 12 cm and return at 18 cm, and the break moves to 15 cm by the third trial. What do you record, what do you write in the report, and what do you deliberately not write?

Name the four skills that run from printed cards and the one setup error that most often invalidates each.

Print one set of VPA™ cards this week, check the calibration mark, and run the print-card skills with a colleague while a second colleague scores you on the 20-item fidelity checklist.

• Progression, basal, ceiling
• The five validity threats
• The 12 skills sit on the five levels
• Keeping a full battery clean

• Entry by age band: Level 1 at 5–7, Level 2 at 8–11, Level 3 at 12–16, Level 4 at 17+. Acuity, contrast, and convergence are fixed two-item checks instead — no ladder, no basal or ceiling.
• Items are scored 0–3; 2 or 3 passes. Pass, move up one level; fail, move down one level.
• Ceiling = fails at two consecutive levels; basal = passes at two consecutive levels. Achieved level = highest level passed. Never score an unreached ceiling as Level 5.
• A Level 1 Visual Access failure triggers referral immediately. A strained pass at entry deserves a step down to confirm the floor.
• Five validity threats: incomplete basal/ceiling, setup deviation, fatigue, attention/behavioral state, unfamiliar content. Suspect fatigue first in Functional Integration.

A 9-year-old (8–11 band) is referred because she cannot find the problem she is working on in a dense math worksheet. In figure-ground she scores 2 at Level 2, 2 at Level 3, then 1 at Level 4 just after a hallway interruption, and 1 when you return to Level 3 to recheck. What is the achieved level, what do you flag, and is the ceiling established?

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

Take one skill and run the ladder on paper for three imaginary students in different bands, writing down each item given, its score, and why the skill stopped. Check each against the rules above.

• 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.
• Read the profile as a cascade, then use P-OSIS™ to turn a treat disposition into service time; both support, and never replace, team decisions.
• 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.