Test-Retest Reliability of
O
the Test of Visual
Perceptual Skills With
Children With Learning
Disabilities
Sheri Ambacher McFall, Jean c. Deitz,
Terry K. Crowe
Key Words: pediatrics. visual perception
This study examined the test-retest reliabilitv of the
Test of Visual Perceptual Skills (nonmotor) -(lirps).
The sample consisted of30 first- and second-grade
children (aged 6years through 8 years) with identified
learning disabilities The TYPS was administered on
two separate occasions that were 1 to 2 weeks apart
The intraclass correlation coefficient for the total test
standard scores was .81. The intraclass correlation co-
elficients for the subtests rangedfrom 33 (Sequential
MemolJ!) to .78 (Form Constancy). The primmyfind-
ingfrom this study is that TYPS scores on the total test
show adequate test-retest reliabilizy for use in clinical
settings. The scores on the suhtests, howeuer, should he
used with extreme caution, as the test-retest reliabilfry
estimates were low.
Sheri Ambacher McFall, ,viS. OTRA, is an occupational rherapist
in the Everett School District, Special Sel'/ices, 202 Alder, Ev-
erett, Washington 98201. At the time of this study, she was a
graduate student in rhe Department of Rehabilitation Medi-
cine, University of Washingron, Seattle.
Jean C. Deitz, PhD. (JTI~'L, FAmA, is A'isociare Professor. Depart-
ment of Rehabilitation Medicine, Universiry of Washington,
Seattle, Washington.
Terry K. Crowe, Phil. OTIVI .. is DircctOl" and Assistant Professor,
Division of Occupational Therapy, Department of Orthopae-
dics ancl Rehabilitation, University of New Mexico, Albuquer-
que, New Mexico.
This article was accepted for publiCa/ion April 21, 1993
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Therapy
ccupational therapists working with children of-
ten assess Visual perceptual abilitIes, along
with fine motor and visual mmor integration
skills, to gather information for use in determining ser-
vice needs or measuring progress (Cook, 1991). Visual
perceptual tests have been used or recommended for use
with children and adolescents who have been referred
because of suspected learning disabilities (Blalock, 1982;
Hagerman, 1984;]ohnson, 1981; Whyte, 1984). According
to Gardner (1982), Visual-perceptual deficits would be
rnore common among children in a "school for learning
handicapped" than in children who are "average learn-
ers" (p. 16). Therefore, assessment of visual perception in
children and adoJescents with learning disabilities seems
\Narranted.
Two standardized, nonmoror tests used byoccupa-
tional therapists and other professionals when assessing
visual perception are the Test of Visual Perceptual Skills
(TVPS) (Gardner. 1982) and the Motor-Free Visual Per-
ceptual Test (MVPT) (Colarusso & Hammill, 1972; Crowe,
1989). The IVPS includes seven subtest areas of Visual
Discrimination, Visual Memory, Visual Spatial Relation-
ships, Visual Form Constancy, Visual Sequential MemOlY,
Visual Figure Ground, and Visual Closure. Each subtest
contains 16 items that, according to Gardner (1982), are
presented in an increasing level of difficulty.
When selecting a test for use with children in clinical
practice or in research. occupational therapists and other
professionals need to consider the reliability of the test
(Benson & Clark, 1982; Deitz, 1989). One essential type of
reliability is test-retest reliability, an index of score stabil-
ity over time (Arlastasi, 1988) that allows therapists to be
confident that score changes reflect change in thc per-
son's rerformance rather than random error. Both Gard-
ner (1982), in the TVPS test manual, and reviewers uiti-
quing the TVPS in The Ninth Jl![ental lvleasurernents
Yearbook (Busch-Rossnagcl, 1985; Denison, 1985) indi-
catcd the need to examine teSt-retest reliability for this
measure. This study addressed the identified need by
focusing on the stability ofTVPS scores. First- ancl second-
grade children (6 to 8 years old with identified learning
disabilities) were selected because these are common
grades in which children with classroom difficulties are
referred for occupational therapy evaluations in the pub-
lic school s\fstem The follOWing research question was
addressed: What are the test-retest reliabilities and per-
centages of agreement for toral TVPS scores and for TVPS
subtest scores for first- and second-grade children with
identified learning cJisabilities l
Method
Sample
A convenience sample of 30 children with identified
learning disabilities (25 boys ancl 5 girls) was tested. A
child with an identifled learning disability was defined as a
819
 child having a qualifying handicapping condition, which Table 1
the members of the public school multidisciplinary team Academic Information Based on Review of Subject's
used to qualify the child for special education and related Special Education Files
services. The handicapping condition of learning disabil- Number of
Characteristic Subjects Percentage
ity is based on the foJlowing definition as stated in the
Washington Administrative Code (1988) (WAC 392-171- Classroom placement
Self-contained 10 333
40): Regular education 2 6.7
Self contained/regular education 1 33
The presence of a specific learning disability is indicated by intel- Resource room/regular education 15 50.0
lectual functioning above that specified in this chapter for eligibil- Other (integrated) 2 67
ity as mentally retarded and by a severe discrepancy between the Currently receiVing support services'
student's intellectual ability and academic achievement in one or Speechllanguage therapy 19 633
more of the following areas: oral expression, listening compre- Occupational therapy 5 16.7
hension, wrillen expression, basic reading skill, reading compre· Physical therapy 4 133
hension, mathematics calculations, and mathematics reasoning: Reading s~ecialist 2 67
provided, that such performance deficit cannOt be explained by Chapter 1 1 33
visual or hearing problems, motor handicaps, mental retardation, Qualifying area for learning
behavioral disability, or environmental, cultural, or economic fac- disability categorf
tors (p. 20). Reading 25 86.2
Math 16 55.2
The children were in first grade (n = 5) or second grade Wrillen language 23 793
en = 25), and ranged in age from 6 years, 9 months to 8 "Child can receive more than one service.
years, 11 months (M = 7 years, 7 months). All of the hFederally funded program with placement based on scores in math or
children in this study were white, and English was their reading one or more grade levels below child's grade level.
(Child could qualify in more than one area for learning disability based
primary language. According to parent report, only one on the Wide Range of Achievement Test or the Woodcock-Johnson
child wore glasses and none of the children had uncor- Psychoeducational Bartery (Woodcock & Johnson, 1977); information
rected vision problems. was missing for one child.
The following information was obtained from ques-
tionnaires completed by the parents. Seven of the chil-
not timed. Administration needs to be done individually
dren were reported to have had problems during or
and requires approximately 20 to 30 min. Tables are pro-
shortly after birth and three were reported to have been
vided in the manual for determining perceptual age,
more than 4 weeks premature. The parents also were
scaled scores, and percentiles for each subtest and the
asked if their child had ever been identified as having one
perceptual quotient, percentile rank, and median percep-
or more of the following problems (answers were record-
tual age for the total test (Gardner, 1982).
ed as yes, no, or possib~y): developmental disability (yes,
7; possibly, 9); large motor problems (yes, 4; possibly, 6);
neurological problems (possibly, 1); a physical disability
(possibly, 4); and seizures (possibly, 1). Data Collection
Academic information was obtained from each Lists of potential subjects were obtained from two school
child's file at the school district's special education office districts in western Washington, and the parents were
(see Table 1). The classroom teacher also completed a sent forms describing the study. With parental consent,
brief questionnaire (see Table 2). The classroom teacher both test and retest sessions were scheduled for each
who completed the form was the regular education teach- child at approXimately the same time of day, either in the
er unless the only teacher the child had was a special morning or in the afternoon. Time between testing ses-
education teacher. sions was 1 to 2 weeks (M = 9 days). This time allowed
for schedule changes due to children's absences or class-

Instrumentation
The Test of Visual Perceptual Skills (non motor) (TVPS) Table 2
was used in this study. The TVPS is standardized and Academic Information Based on Classroom
contains 112 items divided into 7 subtests. The individual Teacher Report
test plates contain four to five forms that were selected Number of
without bias in regard to race, culture, gender, education, CharacteristiC Subjects Percentage
or language (Gardner, 1982). The child is given the direc- Academic area below grade level
tions, shown the test plate, and asked to indicate the Reading 29 96.7
Math 22 73.3
correct response among four to five choices. A child may Written language 29 96.7
indicate his or her answer by pointing, by verbally stating Has difficulty copying off board 17 56.7
the number, or by any other method established by the Reverses letters more than most children 4 13.3
Attention is a concern in class 19 63.3
tester, such as use of a communication board. The test is

820 September 1993, Volume 47, Number 9

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 room requirements. Testing took place at the child's Table 3
school in a small, quiet room that was the same for both Descriptive Data Based on Total Test and Subtest
Standard Scores on Test and Retest (N = 30)
testing sessions. Both the test and retest were adminis-
tered by the same examiner, a pediatric occupational Group M Median SD Minimum Maximum

therapist with 5 years of clinical experience. Total test

Test 972 920 165 640 1290
The TVPS was administered in accordance with the
Retest 1031 1020 192 67.0 147.0
directions in the manual with all items given in each SubleSts
subtest until a ceiling was reached. If a child's choice was Visual
discrimination
unclear to the examiner or if the child changed his or her
Test 119 125 31 5.0 190
mind, the examiner would say, "You need to give me one Retest 130 120 37 50 190
answer." After each testing, the child received a small Visual memory
token for participating. Test 94 100 2.7 30 16.0
Retest 10.5 10 31 30 16.0
Spatial rcl,ltions
Te~l 104 105 41 2.0 17.0
Data Analysis Retest 111 100 43 4.0 190
Form constancy
Data were analyzed in five steps. Standard scores were Test 8.7 90 31 30 17.0
used for data analysis, "vith scaled scores used for the Retest 94 95 33 10 170
Sequenlial memorv
subtests and perceptual quotients used for the total test.
Tesl 84 80 26 40 150
The standard scores reported in the test manual (GaITI- Retest 84 80 2.6 30 13.0
ner, 1982) for the total test are perceptual quotients (AI = Figure ground
100,SD = 15) and for the subtests are scaled scores that Test 92 85 38 20 170
Retest 93 90 37 4.0 18.0
range from 1 to 19, with a scaled score of 10 considered Visual closure
average (!:jD = 3). These scores are commonly used clini- Te'l 95 95 33 4.0 19.0
cally because they are "derived scores that transform raw Re c"[ 114 11.0 38 4.0 190
scores in such a way that the set of scores always has the
same mean and the same standard deviation" (Cermak,
1989, p. 107). total test score and the subtest scores were calculated to
The first step in the data analysis process was to determine the actual differences between the scores.
complete descriptive statistics for all information gath-
ered during this study. Second, test-retest reliability was Results
determined for each of the seven subtests and for the
total test with the two-way random effects repeated mea- Descriptive statjstics for the total test and subtest stan-
sures model of the intraclass correlation coefficient This dard 'scores are repartee! in Table 3. Most scores show a
model considers differences between test and retest tendency toward improvement on the retest The mean
scores as sources of error and provicles reliability coeffi- improvement was 5.9 pOintS for the total test standard
cients that can be generalized to one examiner (Tinsley & scores :lod ranged from 0.0 to 1.9 points for the subtests.
Weiss, 1975). A computer program written by Paulson According to paired t-tests examining the differences be-
and Trevisan (1990) was used to run the intraclass corre- tween the group rneans on test and L"etest, significant
lation. With this program, formula 2 was used Third, diffel"ences (P :5 .05) occurred for the total test scores and
standard errors of measuremenr were calculated with the for the subtests of Visual Closure and Visual Memory (see
square root of the residual mean squares (Fleiss, 1986; M. Table 4).
Trevisan, personal communication, March 23, 1993) Imraclass correlation coefficients (ICCs), standard
Fourth, Pearson product-moment correlations were de- en-ors of measurement, and Pearson produCt-moment
termined for the total test and subtests to facilitate com-
parison of reliability estimates between the TVPS and the
MVPT. In addition, paired I-tests were computed to deter- Table 4
Paired t-tests between Group Means on Test and Retest
mine any significant differences between mean scores on
I value p value (two-tailed)
test and retest for the total test and the subtests.
Analyzing the percent of agreement betvveen the test TOLal lest -328 003*
SubteSlS
and retest for each of the seven subtests and for the total Vbual discrimination -189 069
test was the fifth step in data analysis Analysis of the Visual memory - 2.41 .022'
difference between the standard scores obtained during Spalial relations -112 271
Form constancv -176 089
the two testing sessions shows that the clinical implica- Sequential memory 00 1000
tions of the differences are evident The magnitudes of Figure ground - .11 .911
difference (larger score minus smaller score) between Visual closure - 317 .004*
individual test and retest standard scores for both the "p < .05

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7herapJ' 821
 Table 5 Table 7
Intraclass Correlation Coefficients (ICCs), Standard Magnitudes of Difference Between Subtest Standard
Errors of Measurement (SEMs), and Pearson Product- Scores on Test and Retest
Moment Correlation Coefficients for Test-Retest Magnitude of Difference
Reliability for Total Test Standard Scores and Subtest
Standard Scores (N = 30) Negative Positive

ICC SEM r 7-8 5-6 3-4 1-2 0 1-2 3-4 5-6 7-8
Visual discrimination
Total test 81 7.0 86
Subtcsts
Number of suhjects 5 5 5 4 6 3 2
Visual memorv
Visual discrimination 55 23 58
Visual memory .62 17 66 Number of subjects 5 6 10 4 3
Spatia) relations
Spatial relations .70 23 .70
Form constancy .78 15 .80 Number of subjects 4 2 8 7 5 2
Form constanq'
Sequential memol")' 33 2.1 33
23 Number of suhjects 3 5 4 14 2 2
Figure ground 63 63
Sequential memol")'
Visual closure 52 23 59 Number of subjects 2 3 10 4 6 2 2
Figure ground
Number of subjects 4 8 7 6 2
Visual closure
correlation coefficients for test-retest reliability for total Number of subjects 4 3 2 7 8 4 2
test standard scores and subtest standard scores are pre-
sented in Table 5. Magnitudes of difference between total
test standard scores for test and retest are reported in
33 (Sequential Memory) to .78 (Form Constancy). These
Table 6. ApproXimately 77% of the subjects obtained a
results suggest that the stability of scores for children
higher score on retest total scores as compared to test
with an identified learning disability is adequate for the
total scores. Magnitudes of difference for the subtest stan-
total test but is generally poor for the subtests. Therefore,
dard scores are reported in Table 7. For the magnitudes
less confidence should be placed in the stability of subtest
of difference, the percentages of all subjects who im-
scores.
proved, showed no change, or declined in standard
When reliability was examined for the TVPS with
scores for each subtest are shown in Table 8. For six of the
Pearson product-moment correlation coefficients, higher
seven subtests, 50% or more of the subjects showed im-
coefficients were reported than with the ICe. However,
provement on the retest.
paired t-tests indicated a significant difference between
test and retest scores for the total test scores and subtest
Discussion scores of Visual Closure and Visual Memory. This differ-
ence appears to reflect a practice effect. Intraclass correla-
The test-retest ICC obtained in this study for the TVPS
tion coefficients consider this type of systematic change
total test was .81. For the subtests, the ICCs ranged from
to be part of measurement error; therefore, intraclass
correlation coefficients probably provide better estimates
Table 6
of test-retest reliability on this measure.
Magnitudes of Difference Between Total Test Standard In addition to the TVPS, occupational therapists also
Scores on Test and Retest use the l\1VPT to assess visual perception. For the MVPT,
Number of Percent of Pearson product-moment test-retest coefficients ranged
Magnitude of difference Subiects TOlal Sample from a low of .77 (4-year-olds) to a high of .83 (6-year-
15-16 1 33 olds), with a coefficient of .81 for the total sample of 162
13-14 1 33 subjects who were considered to be typically developing.
11-12 1 33 Professionals who have both tests available may
9-10 1 33
7-8 o 0.0
5-6 o 0.0
3~ 1 33
(-) 1-2 1 33 Table 8
o 1 33 Magnitudes of Difference Between Subtest Standard
(+) 1-2 2 6.7 Scores on Test and Retest
3~ 2 67 Percent Percent Percent
5-6 3 10.0 Declined No Change Improved
Subtest
7-8 3 10.0
9-10 3 10.0 Visual discrimination 33 17 50
11-12 1 33 Visual memory 23 20 57
13-14 4 133 Spatial relations 23 27 50
15-16 2 6.7 Form constancy 27 13 60
17-18 1 33 Sequential memory 50 13 37
19-20 1 33 Figure ground 47 3 50
>21 1 33 Visual closure 23 7 70

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 need to weigh several factors when deciding which test to
use. First, it may take less time to use the MYPT, which
has only 36 items. Second, obtaining subtest scores has
been considered a benefit of the TVPS (Gardner, 1982).
However, because of Jow reliability estimates, extreme
caution is indicated when using these scores. Third, the
TVPS provides normative data for a broader age range (4
through 12 years) as compared to the MVPT (4 through 8
years) .
Score stability on the Figure Ground subtest of the
TVPS also can be compared to the Figure Ground subtest
of the Southern California Sensory Integration and Praxis
Test (Ayres, 1989). A test-retest reliability study was com-
pleted for the latter subtest using a sample of 41 children
with learning disabilities and a mean age of 6.5 years
(Ayres, 1989). The reliability estimate for this measure
(1' = .54) was slightly lower than that for the Figure
Ground subtest of the TVPS (1' = .63).
Percentage agreement also was used to examine the
stability of test scores. Examining percentage agreement
allows a closer look at the comparison between two sets
of scores based on absolute values. Clinically, even small
point differences in scores may be enough to influence
service need decisions or potential programming deci-
sions. Examination of the percentage changes based on
the magnitudes of difference shows that 50% or more of
the subjects improved on retest for all of the subtests
except Sequential Memory (see Table 8) On the basis of
these results, some instability appears to be evident in the
scores on the subtests.
When the magnitudes of difference between the to-
tal test scores for test and retest were examined, 76.7% of
the subjects obtained a higher score on the retest. Exami-
nation of the total test scores (see Table 6), shows that 5
of the 30 subjects obtained retest scores 15 points or
more higher than their test scores and 1 subject obtained
a score 16 points lower on the retest. Therefore, 20% of
the subjects' scores changed by one standard deviation or
more between test and retest. Such a change could affect
decisions that may be made about a child's visual percep-
tual abilities.
The ability to generalize the results of this study is
limited by two factors. First, only one rater was used for
both testing sessions. The increased familiarity with this
rater at the second testing session may have caused some
children to perform differently at the second testing even
with the attempt to keep testing consistent. Results are
therefore only generalizable to situations in which the
same tester completes the initial testing and provides
treatment before retesting the child at a later time. This is
a common situation in the public school system. Second,
the sample was small and only represented two school
districts in one geographical area. If the current study
were replicated with a larger sample from a more diverse
area, therapists could have even more confidence in the
stability of the reliability coefficients generated.
The American Journal oj Occupational Therapy
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According to some authors (Blalock, 1982; Hager-
man, 1984; Johnson, 1981; Whyte, 1984), children with
learning disabilities may have suspected deficits in visual
perception. When completing the standardization and
norming process for the TVPS, Gardner (1982) compared
45 students who attended a school for the learning handi-
capped with a matched group from the standardization
sample. The children were matched on the basis of age,
gender, and race. The mean age of the children in his
study was 10.11 years. On the basis of ANaYA, Gardner
(1982) noted lower performances for the group of chil-
dren with learning disabilities.
The children in the current study qualified as learn-
ing disabled and had a mean age of 7 years, 7 months.
Their total scores reflect overall performances near the
mean (test: M = 97.2; retest: M = 103.1). Therefore, the
6- to 8-year-old children with identified learning disabil-
ities who participated in this study showed average per-
formances on this visual perceptual test. The discrepancy
between the performance on the TVPS of subjects in our
sample as compared to the performance of subjects in
Gardner's sample leads to the question of whether chil-
dren 'with learning disabilities have visual perceptual defi-
cits as measured by the TVPS. Further research is warrant-
ed in this area, possibly examining the visual perceptual
skills of subgroups of children of specific ages whose
learning disabilities are reflected in specific types of aca-
demic performance deficits.
Conclusion
Results of this study suggest that when the TVPS is admin-
istered to 6- to 8-year-old children with identified learning
disabilities, the stability of total test scores can be consid-
ered adequate. \Xfhen used for determining progress,
these scores should be interpreted cautiously, as they
showed an overall increase on the retest even with no
intervention. Test-retest reliability estimates for the sub-
tests ranged from low to borderline acceptable; there-
fore, these scores are of limited use for determining ser-
vice needs and documenting progress .•
Acknowledgments
We rhank rhe children from rhe Evererr and Norrhshore School
Disrricts who participated in rhe srudy. This srudy was support-
ed in parr by rhe Paula M. Carman Memorial Fellowship Fund.
References
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Benson,J, & Clark, F. (1982). Aguide for insrrumenr devel-
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Busch-Rossnagel, N. A. (1985). Review of Test of Visual-
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ment. AJlen, TIC DLM Teaching Associates.

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