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A letter sent to the editor raised a very interesting and important question that school psychologists are frequently confronted with:

"I have been trying to find out how to interpret a very specific incident that occurs frequently on the WISC as well as on other IQ tests. .... My question is, what does it mean when a child rotates the blocks during the Block Design subtest? Is it solely an indication of visual perception problems? Also why are there different criteria for scoring the degree of the rotations"

Block Design type tasks have been common on intelligence tests since at least 1923 when Kohs incorporated them. The Wechsler Scales' Block Design, the Stanford Binet 4th Edition's (SB-4th) Pattern Analysis, The Differential Ability Scales' (DAS) Pattern Construction, the Kaufman Assessment Battery for Children's (K-ABC) Triangles, and the Kaufman Adolescent and Adult Intelligence Test's (KAIT) Memory for Block Design are all varying forms of the block design task. Each has slightly different scoring and timing procedures. For example, the Wechsler Scales incorporate red and white plastic blocks, have strict time limits, and penalize rotations greater than 30°; the DAS, using black and yellow blocks, allow the examiner to score with and without time limits; the SB-4th, with its black and white blocks, penalizes rotations of 90°; the K-ABC, using yellow and blue foam boards, does not penalize rotations at all; and the KAIT, with large black and yellow wooden blocks, has lenient time limits and a tray provided for the examinee to construct the design in. With all the variations of the task, how is one to interpret the rotation and reversals sometimes encountered?

These authors contacted, by letter or phone, the following test experts: Dr. Aurelio Prifitera, Director, Psychological Measurement, Vice President, The Psychological Corporation; Dr. Jerome Sattler, Professor of psychology at San Diego State University and co-author of the SB-4th; Dr Colin Elliott, author of the DAS and project manager for the KAIT; and Dr Alan Kaufman, Research Professor, University of Alabama and the co-author of the KABC and the KAIT. (In this article, all quotes, unless otherwise cited, are from personal communications with these authors.)

Each of these experts were consistent in at least one area: that extreme care and caution needs to be applied when making any specific interpretation. Each generalized assumption must be tempered with an understanding of the individual being tested. As Dr. Sattler noted, examiners must keep in mind that "...no one error should be interpreted without reference to the entire performance." This is clearly a tenet that most school psychologists hopefully understand and follow. Beyond that caution, there are some possibilities as to what a rotation or a reversal might imply.

Pathognomonic possibilities for rotations and reversals

From an historical perspective, Dr. Prifitera noted that "Wechsler originally hypothesized that rotations were associated with reading disabilities in children.

Drs. Prifitera and Sattler briefly addressed the association between rotation errors and pathology. Dr. Sattler wrote, "It could mean a possible brain injury...". Dr. Prifitera, in his response, went even further in saying that alignment errors, "...are often associated with right hemisphere dysfunction...". Consistent with this statement is Kaplan, et. al.'s (1991) research finding that patients with right frontal brain damage commonly rotate block designs. However, also cited by Kaplan are studies which implicate left hemisphere dysfunction as the culprit in single-block rotation errors (Delis, et. al., 1986, 1988). This example of the existing dichotomy in the research presents reason to decide with care what it is that Block Design rotations signify. The overall consensus on the neurological implications of block rotations seems inconclusive. Various studies, cited in Kaplan, et. al.'s (1991) suggests that a low score on the subtest could mean that the left, right or both hemispheres are damaged.

Since the research data cited above was specific to adults and the WAIS-R, these authors ran a literature search using the PsychLit data base to retrieve articles specific to children's block rotations. Searching all articles from January 1987 to June 1994, and using combinations of terms (WISC, Block Design, rotation, error, analysis, perception, performance, implication, neurological, etc.), no direct references to studies involving children were found. This same search, substituting the term WAIS for WISC resulted in a larger number of articles. This data base search suggests a paucity of data relevant to interpretation of rotations for children. Can we assume that the interpretations relevant for an adult would be equally relevant for a child?. The reminder of Reschly and Gresham (1989) seems relevant on this point

"Neuropsychological explanations of common learning problems are based on studies of highly selected and often, extraordinarily rare individuals, and then generalized to students whose developmental and neurological status are clearly different from persons included in the basic research. These generalizations often involve inferences from persons with definite brain damage to children who have no identifiable brain injury."

Non-pathognomonic reasons for rotations

Although rotations can be related to brain pathology, other explanations are always possible. The reason for a child rotating a block design may be as simple as "a wild guess", as Dr. Sattler put it. Dr. Kaufman, in his letter noted a very interesting observation from the standardization of the K-ABC. When he and his colleagues tested children during pilot studies on the Triangles subtest, they often questioned children who rotated designs as to why. The children answered, "So you could see the design better", or "So it would be easier for you to know if I got it right". Dr. Elliott concurred with this finding, noting "For young children, they just may not tune into the requirements for keeping things in proper orientation. Do they even perceive that it matters? Particularly on tests that do not have the examiner seated in the same orientations as the child, the child may rotate to please the examiner."

The developmental model also holds a good argument for rotations possibly being normal. Kaufman, in his explanation of why the K-ABC does not penalize for rotations, wrote that children 4 to 5 years of age may not be expected to attend to these features. At ages 6 to 8, rotations are more meaningful, however, there is still research that indicates that, "...it is normal for some children to reverse letters and to be unable to answer reversal or rotational items correctly." Sattler, in his letter to these authors, also mentioned this possibility of perceptual immaturity. Therefore, one should take care in considering the child's overall development and consider the possibility that a rotation may not have any negative meaning.

Why tests penalize differently

Regarding the rationale for judging varying degrees of rotations as an error or not, there was no one reason cited by the experts. Dr. Sattler noted that "There is no answer to why some tests penalize for 30 degrees and 90 degrees, or not at all. This is a judgment made by test constructors." Dr. Prifitera notes that "Wechsler used the 30 degree criteria for consistency and standardization in scoring." Dr. Kaufman summarized the rationale for not scoring rotations on the K-ABC by noting "We did not feel confident that rotations should always be interpreted as potential for school-age children, and we were quite sure that rotations by children ages 4 to 6 or 7 (or even 8) may have no negative meaning at all. Consequently, we believed that the best way to handle the situation was to penalize no one for rotations."