My report from the autism research study

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I just received the written report from the autism research study at the University of Pittsburgh. As some of you know, the study rejected me as I did not meet their diagnostic cut-offs after taking the ADOS. I thought I would share the report on WP. I found some of it interesting and maybe many of you will as well.


So here goes:



Identifying Information:

Name, Horus, the falcon-headed idiot god
Date of birth, 6-6-2006 BC
Date of evaluation, 9-20-2010
Chronological age, Begotten... not made.... before all legends of man
Years of Education, 14 years

Assessement Measure:
Autism Diagnostic Observation Schedule (ADOS)
Autism Diagnostic Interview-Revised (ADI-R)
Wechsler Abbreviated Scale of Intelligence (WASI)
Wide Range Achievement Test-4th Edition (Blue Form)-Reading subtest

Reason For Evaluation:

Horus was seen for an evaluation at the NIH center for Excellence in Autism Research at the University of Pittsburgh to determine eligibility for our research program on high functioning autism. Assessment results are for research purposes only. This is not a clincal diagnosis.


Diagnostic Assessment Results:

Autism Diagnostic Observation Schedule
Administrator: Jane Doe, M.S.

The ADOS, Module 4, was administered to determine whether Horus would meet our criteria for research participation. The ADOS is administered to evaluate the presence of observable behaviors often associated with a diagnosis within the autism spectrum. The ADOS is a semi-structured interactive assessment in which the child, adolescent, or adult is presented with a number of situations, tasks and demands. The evaluator is provided the opportunity to observe behaviors across (4) domains: communication, reciprocal social interaction, imagination/creativity, and stereotyped behaviors and restricted interests.

Communication

In communicating, Horus primarily used complex speech. On several occasions during the interview, he utilized a more formal vocabulary accompanied by a slightly monotone intonation of his voice. He did not echo the words and phrases that the examiner produced. Furthermore, Horus produced informational, descriptive and emphatic gestures and used them appropriately.

Horus spontaneously offered information about his thoughts, feelings and experiences on a variety of topics throughout the interview. He had some difficulty asking his conversational partner about her thoughts, feelings and experiences. Therefore, the conversation lacked the level of reciprocity expected for an individual with his language. Horus had no difficulty reporting a non-routine event such as a trip or a routine event such as brushing his teeth.

Reciprocal Social Interaction

Horus frequently directed his gaze and facial expressions to his conversational partner during the interview, although at times, he had some difficulty modulating his eye contact with his speech and gestures. Horus also had some difficulties communicating to his conversational partner how he feels when he is happy, sad, angry, or anxious. On the other hand, he had no difficulty communicating an understanding of shared emotion of others during the interview. Additionally, Horus demonstrated some insight in his own behavior and its effect on social interactions.

Overall, Horus' social overtures focused on involving the examiner in a conversation about his area of interest. However, most of his social responses were appropriate to the situation. Even so, the reciprocity of Horus' conversation was less than would be expected given the amount of language he produced during the interview.

Stereotyped Behaviors and Restricted Interests

During the interview, Horus did not appear to have a sensory interest in any of the materials presented. At times, he made reference to highly specific topics (i.e., WWII weaponry, etc.). Horus also appeared to have a ritualistic quality to his communication in that he seemed to have a strong desire to complete his thoughts.


Autism Diagnostic Interview-Revised (ADI-R)

Informant: Isis, Biological mother
Administrator, John Doe, B.S.

The ADI-R is an investigator-based structured interview. The ADI-R is administered to the participant's principal caregiver with a purpose of obtaining detailed descriptions of those behaviors that are necessary for the differrential diagnosis of pervasive developmental disorders (PDD) and especially for the diagnosis of autism. The interview focuses primarily on the key diagnostic characteristics specified in ICD-10 and DSM-IV; specifically those features concerned with developmental delays and deviance in reciprocal social interactions, language, communication and play, and on restricted, repetitive and stereotyped behaviors and interests. Most items are scored for the period of development considered most abnormal by the ADI-R, which is 4-5 years old.

Horus' mother reported a development pattern in the domains of social interaction and communication that is similar to what is known about the developmental sequence of children with an autism spectrum disorder. During Horus' childhood, he had some difficulty using nonverbal behaviors to regulate social interactions, lacked socioemotional reciprocity, and had some difficulty initiating and sustaining social conversations. His mother's responses to the interview questions resulted in an overall score, which met the cut-off scores for having an autism spectrum disorder.


Intellectual Ability

Horus was administered the Wechsler Abbreviated Scale of Intelligence (WASI), an abbreviated form of an intelligence test. The WASI a is standardized, normed and validated short form of both the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) and the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). The WASI is used to test the general thinking and reasoning skills of individuals aged 6 to 89. This test has three main scores: A Verbal score, a Performance score and a Full Scale score.


With a chronological age of 4500 years, Horus obtained a an observed Verbal IQ (VIQ) in the Superior range. His observed VIQ was 126. This means that he performed as well or better than 96% of individuals his age. Horus' observed Performance IQ (PIQ) on the WASI was 84. This is in the Low Average range. He performed as well or bettert than 14% of those his age ( ) on this measure. Horus' Full Scale IQ score is not being reported, because it is not an accurate and valid way to summarize his intelligence skills. The FSIQ is essentially a summary of all the subtest scores from both the VIQ and PIQ subtests, which would be invalid in Horus' case because of the large and rare split (which is ALWAYS present...even though all my scores have been both higher and lower respectively on the seven other professionally-administered IQ tests i've taken in my life-Horus) between his VIQ and PIQ scores. His intelligence skills cannot be accurately summarized in one overall number; rather he should be thought of as having Superior verbal intelligence skills and Low Average nonverbal intellligence skills.

It must be noted that IQ test primarily predict school and academic succcess rather than real life adaptive skills. That is why IQ scores and functioning in real life diverge in autism, most dramatically after graduation from high school. Also, in the normal IQ range, the tests of language cease to be sensitive to the deficits in verbal individuals with autism, which lie in idioms, metaphors and gist analysis. Thus, the IQ test provides limited guidance about deficits in autism.


Subtest T-score
Vocabulary 68
Block Design 28
Similarities 62
Matrix Reasoning 50


-T scores have a mean of 50 with a standard deviation of 10. T-scores between 40-59 are considered to be in the Average range.

-IQ index Scores have a mean of 100 with a standard deviation of 15. IQ index scores between 90-109 are considered to be in the Average range.


Achievement

On the measure of Academic achievement, the Wide Range Achievement Test-Fourth Edition (WRAT-4) Reading section, Horus obtained a score in the Superior range. He obtained a Standard score of 123, which means that he scored as well or better than 94% of individuals his age.

Summary


Horus does not meet the eligibility requirements for high functioning autism as defined by our research protocol. This was determined by the results of the diagnostic instruments, the ADOS and ADI-R clinical impression, and record review. Specifically, his symptom scores on the ADOS were too mild for participation in the study. In order to maintain consistency within the studies, it is necessary for all participants to have a similar level of functioning. All tests were administered for research purposes, but the scores are included for your convenience.

It was a great pleasure to meet Horus. His participation in helping us further improve the lives of individuals with autism and their family is greatly appreaciated. If there are any questions about this assessment, please feel free to contact our office at anytime.



Thus spake the tutelaries at the University of Pittsburgh's autism research study. I met their cut-off scores on the ADI-R.....but not on the ADOS. I sent them copies of all five neuropsycholgical evaluations i've had in my life and they were well-aware of the fact that I had not been officially dx-ed with any ASD on any of them. These neuropsych evals all suggested that I exhibited the "classic" characteristics of NVLD/NLD, but NLD is neither officially considered an ASD nor a formal Mental Disorder dx in the first place. Furthermore....I was dx-ed with Schizotypal personality disorder on all but one of these neuropsych evals. I also brought them a copy of the most recent neuropsych eval I had in June. This eval didn't yield any ASD dx either, but the NVLD/NLD characteristics were roughly the same as they were on all my other evals. I was also dx-ed with Schizoid Personality Disorder (with Schizotypal and Avoidant features) on this current eval. I have firmly believed Schizoid pd suited me better than Schizotypal pd for a long time now anyway, but the psychologists just seem to nonchalantly and politely dismiss everything their patients say.


Still....none of this addresses the life-long and severe memory problems I believe I have which have never yet been diagnosed after more neuropsycholgical testing in my lifetime than most people will have in 100. PERHAPS something more could've been determined about those had I been accepted into the study. The study included fMRI scans, but structural whole-brain images may have been available as well. If any gross abnormalities were seen in regions of my brain within or without the ones associated with memory, I likely would've been informed of them. This was pretty much the entire reason I wanted to participate in this study in the first place.

I can't afford neuroimaging out-of-pocket and my insurance won't pay for it. While the neuropsycholgist who just evaluated told me it's entirely possible I could have significant memory problems which elude the standard neurocognitive tests of memory (which would include the tests he himself used), he wouldn't recommend any further testing (which might include neuroimaging and he said a PET scan might be the most useful type of scan in my case) to OVR. OVR ordered this evaluation and covered the costs of it. It hardly matters anyway since OVR probably would refuse to pay for any neuroimaging even if the neuropsychologist would've recommended any. They have faced major budget cuts in recent years and from what I know, they're not nearly as generous towards their disabled clients as they once were.

No other research studies....including others involving autism or memory/memory disorders would even consider me as a participant. Largely because I lack an official AS dx or because most of the memory/memory disorders studies are involved in Alzheimer's (and/or other age-related dementias/memory disorders) research.

Bottom line.....i'm currently screwed insofar as accessing any diagnostic means which may finally determine the origin and nature of these extremely debilitating memory problems I believe I have.

One thing i've observed for a very long time is my performance on the Block Design subtest on the Performance IQ section of WAIS as opposed to my performance on the Matrix Reasoning subtest on the PIQ section.


I score significantly better on matrix reasoning than I do on block design. I believe this has much to do with my deficits in processing speed, which have been objectively determined on almost all the neuropsych evals i've taken. Block Design is a timed test whereas matrix reasoning is not. Also....block design has a motor componant and matrix reasoning does not. I also have objectively determined deficits in my psychomotor skills, though I can't be sure if these impact my performance on the block design subtest.

Matrix Reasoning is a test of pattern recognition/non-verbal reasoning on the WAIS IQ tests which was modeled on the famous Raven's Progressive Matrices IQ test. MR is considered a reliable test and I have scored as high as the 91st percentile on it. I have also scored in the low average, high average and squarely average ranges on the MR test. I NEVER have scored higher (though never lower either) than the low average range on the block design subtest. This leads me to believe my weakness in "nonverbal intelligence" has at least as much to do with processing speed deficits (at least when it comes to visual processing) and possibly, psychomotor difficulties as well, as it does with any actual inability to comprehend nonverbal material. On the WAIS I had in 2006, I scored in the high average range on PIQ at 111 and I also scored 155 on VIQ on that same test. These two scores combined yielded an FSIQ of 143, which is in the very superior/genius range.

Unfortunately...the neuropsych did not include the subtest scores on the report, so I don't know how exactly I scored on either the verbal or performance subtests. Still.....I have scored in the borderline intellectual functioning range on PIQ/POI on three out of the seven (I actually have now taken eight professionally-administered IQ tests in my life. My first was in 9th grade and I have no record of it. All I remember of that one is my FSIQ score......120) WAIS IQ tests i've taken in my life and that's making me feel quite bad about myself. Two of these borderline scores were from the recent WAIS tests, the one I took in June and the one I just had at the autism research study. My remaining four PIQ/POI scores have been strictly average or high average on the WAIS in 2006.


Anyway.....thought i'd share the results of the autism study that never was for me. Any comments would be welcome and I will respond to any questions ASAP.



Btw.....I am finally back home in Florida after a 20 days in my hometown of Pittsburgh, Pa. I was killing (or trying to do so anyway) two birds with one stone on my trip to Pittsburgh. I was trying to get accepted in this autism research study at Pitt and visiting with my grandfather, father, step-mother, half-sisters and brother and other relations. All in all I had a nice time with my family and Pittsburgh is a wonderful old town in general. Great food, vibrant cultural/intellectual/music scene, lovely old-world architecture in parts of town, etc......Alas....i'm stuck in this tropical wasteland for the foreseeable furture though. While South Florida has many natural and climatic attributes Pittsburgh (and most of continental U.S. for that matter) lacks, it sucks in just about every other way IMO.


I no longer value the climate and natural environment down here as much as I once did. I would love nothing more than to return to Pittsburgh with all it's old world charm and attend one of the fine Universities there like Pitt, Carnegie-Mellon or Duquesne. As usual....lack of finances is the major hindrance to that however and I guess i'll be stuck attending one of the office buildings/industrial parks which are passing themselves off as colleges/universities here in South Florida.

Interesting. It appears that you can modulate social interactions appropriately enough with eye contact and some reciprocity to fail their standards. Those standards must be quite high. They must be looking for full blown AS. It is note worthy that they consulted your mother, and concluded you met all the requirements for autism in your formative developmental years, but not now as an adult? Does not make sense, but it is difficult to know exactly what the researchers are thinking in these sorts of evaluations, unfortunately. I must say that your performance on the block design test does probably indicate some sort of memory problem. Normal memory processing would not be affected by the delays inherent in this paradigm. I also was diagnosed with schizoid personality disorder before the conclusion that I have AS. An overall IQ score of 143 is impressive. An increase of 23 points from a Junior high score is probably not unusual. The brain does not fully mature until adulthood and education and experience increase our abilities to score well on IQ tests. I suspect alot of people who have high functioning autism, also possess superior IQ. Its just too bad it has to come with these social deficits. Anyways, I am glad you posted the ASOD results. It shows how they reached some conclusions about your interactions in their testing procedures.

This statement does not rule out a spectrum dx, but it does cause me to question what they are looking at and how limiting the range of individuals would provide accurate data. Do you have this information?

Also, I had similar experiences with psychs.

Everyone 'knew' there was something 'wrong' with me. I was given tests with weird results and the psychs could not interpret them in a helpful way. I ended up attending graduate school, learned about autism, and self diagnosed. About that time, aspergers was finally identified as a dx. Then finally, I returned to psych-world and was given an official DX of aspergers.

While that provides me with no help, it does help to explain me to me. Unless you are in our shoes, one does not understand the agony that a split IQ can cause: one fluctuates between savant and idiot with no middle ground. It is confusing to self, family, friends, coworkers, and employers.

Also, my grad degree is in speech language pathology, and I can confidently state that the APA does not have a good understanding of speech, language, or communication. There are way too many people with speech/language deficits being erroneously labeled cognitively impaired and those with superior speech/language skills being brushed off as being just fine.

However, in my experience, while auties by deffinition have reduced ability to communicate verbally, aspies exhibit hyperability (hyperlexia, hypervocabulary, hypersyntax), but surprising difficulty expressing ourselves in a way that typical people can understand and relate to. I have struggled so hard to write reports using vocabulary and syntax that a typical parent can access. The APA has totally missed this aspect, and does not recognize the communication issues are seen with aspies (probably too busy looking up all those big words).

Also, although the DSM IV recognizes as diagnostically relevant “(III) The disturbance [aspergers syndrome] causes clinically significant impairments in social, occupational, or other important areas of functioning.” Yet we are exempt from help to address this incredibly important issue resulting in under=employment, unemployment, and higher than average suicide rates. They give us our dx and throw us back into the concrete jungle to fend for ourselves – the rotters!! !!

Psychs, taken as a group, still don't understand spectrum disorders - the field desperately needs more aspies!!



You have probably looked into this deeper than I have, but I found some info on the two subtests that you seem particularly interested in

Clin Neuropsychol. 1999 Nov;13(4):396-404.
WAIS-III Matrix Reasoning test performance in a mixed clinical sample.
Dugbartey AT, Sanchez PN, Rosenbaum JG, Mahurin RK, Davis JM, Townes BD.
University of Washington, Seattle, WA, United States of America.
Abstract
This study examined the relationship between the Matrix Reasoning subtest (MRT) of the WAIS-III and a selected number of neuropsychological tests in a heterogeneous clinical sample of English-speaking American (n = 41), and non-English-speaking immigrant (n = 14) adults. A moderate association between the Halstead Category Test and the MRT (-.58) was found in the English-speaking sample. Multiple regression analysis revealed a significant association between measures of verbal abstract reasoning and verbal fluency, and performance on the MRT. Among the immigrant sample, the MRT was also found to be significantly associated with verbal fluency task performance, as well as with the Comprehensive Test of Nonverbal Intelligence. Correlational analyses therefore suggest a strong verbal mediation element in the MRT, and that labeling it a nonverbal task may be misleading.

http://en.wikipedia.org/wiki/Block_design_test
"Good performance on the block design test is indicative of appropriate functioning of the parietal and frontal lobes. The Block Design test is also a relatively accurate measure of spatial ability and Spatial Visualization Ability used in daily life[3]. The Block Design test is considered one of the best measures of spatial ability, although it is subject to certain problems of administration, such as testee anxiety or over-cautious responding. Linda Kreger Silverman has proposed the block design subtest as the best putative measure of spatial ability among the Wechsler subtests[4].

Uta Frith, in her book Autism: Explaining the Enigma,[5] addresses the superior performance of autistic individuals on the block design test. This was also addressed in this earlier paper.[6] A particularly interesting article demonstrates the differences in construction time in the performance of the block design task by individuals with and without Asperger syndrome. An essential point here is that in an unsegmented version of the task, people with Asperger syndrome performed significantly faster than neurotypical individuals.[7]"

NLD is defined by deficits in Spatial Visualization Ability, but is otherwise remarkably similar to aspergers in terms of presenting with social and language issues.

I really don't know much about their exact criteria/standards, but I think they're going strictly "by the DSM-IV" for Asperger's/Autism. I believe that, with the exception a few associated symptoms I don't exhibit (or only mildly manifest), an Asperger's dx would be warranted for me. I do have problems with eye contact and non-verbal expressions/gestures. These issues are circumstantial however and largely depend on my mood and especially, the individual/s in my presence. I am as comfortable around mental health professionals as I am around any human beings. Thus, it stands to reason (as far as i'm concerned) that my eye contact and nonverbal communication is going to be less "AS/ASD-like" around them.



Again....I also believe I display stereotyped and repetitive routines, interests and behaviors. My supposed lack of these was the stated reason I did not receive an AS diagnosis on any of my neuropsych evals.

When I consider the features which seem common among those AS which I definitely DO exhibit though, I really think my brain is very similar to many of those with AS. Therefore, whether I fit all the technical classifications for AS or not, there is little doubt many of my own issues share a similar, if not identical, etiology as those of person officially dx-ed with AS.

For example...I have objectively confirmed issues with processing speed, executive functioning, psychomotor skills, sensory issues, (though mild ones), etc....Many people with AS also have issues with all, or at least some, of these things.

Also....I have a significant discrepancy between my VIQ and PIQ (in favor of VIQ) which, although common in those with NLD/NVLD, is also pretty common in those formally dx-ed with AS. I have plenty of problems with visual-spatial skills and almost everyone with NLD has some issues in this area. They may not occur in everyone with AS....but they do occur often enough.


The whole thing about my mother is noteworthy. The trouble is....she knew how much I wanted to get accepted into this study so it's possible (though she vehemently denies this) she told them what they wanted to hear. Also...my early childhood was a very long time ago and thus her memory of my behavior back then is surely not perfect.



I've never been told that my performance on the block design subtest was indicative of any sort of memory problem. I've never heard that memory plays any role on one's performance on that subtest at all before now in fact. If this is true, what aspect of memory does play a role in the block design subtest? Keep in mind that the only memory problems I exhibit WHICH HAVE OBJECTIVE CONFIRMATION are deficits in visual memory. These are supposedly fairly mild for one thing and for another, visual memory deficits are extremely common in those with NLD and MAYBE to a lesser extent, those with Asperger's. So unless my poor performance on block design is associated with my deficits in visual memory, I just don't have any clinical confirmation of any other memory problems. Nor have I ever heard that the poor performance on the block design subtest is somehow suggestive of any sort of memory deficits. Do you have a source for this? Not that I don't think you're credible, this is just something i've never heard before and i'd like to read more about it.





Well....it really didn't work this way though. I don't remember why exactly, but I was given an IQ test (I don't even remember if it was a Wechsler test or what...such things meant nothing to me at the time) in 9th grade. All I know is that my guidance counselor told me my IQ was 120 and i'm sure she was referrring to the full scale score. I took another IQ (a WAIS) test as part of the first actual neuropsychological eval I had at 23. I obtained a full scale score of 94 on that one with a VIQ of 104 and a PIQ of 82.


All the IQ tests (again...all of them were part of a neuropsych eval and all were WAIS tests) I took after this one at 23 and BEFORE the one in 2006 in which I scored 143 have yielded higher scores across the board.

My VIQ scores were 125, 127 and 119 respectively on these and my PIQ scores were 94, 102 and 100. These resulted in FSIQ scores of 112, 116 and 112 respectively. In other words...in the high average on two and the above-average range on one. Then came the WAIS in 2006 which yieled a VIQ of 155, a PIQ of 111 and the FSIQ of 143. On my most recent neuropsych eval/WAIS which I had in June, my PIQ,or POI index score more accurately, was the lowest it's ever been at 79. My Verbal Comprehension score was still pretty high at 136 though. Along with my working memory index score (111) and my processing speed index score (86)...this yielded an FSIQ of 104.


The short-form WAIS (Which included the four subtests from the WAIS with highest reliability coefficient <AFAIK. There were two subtests from verbal and two from performance) I just took at the autism research study yielded a VIQ of 126 and a PIQ of 84.


In short....my FSIQ, VIQ and PIQ scores have been all over the place down through the years. Nonetheless....the split between VIQ and PIQ has always been present and the discrepancy has been as large as 57 points and as small as 19 points. I don't know for certain if the discrepancy was present on the first IQ test I had in 9th grade, but i'm pretty sure it was. Such discrepancies (at least when it came to a VIQ higher than PIQ) weren't given much consideration in those days and again, I only received my FSIQ score on that one in any case.



I think many with high functioning autism/AS possess superior IQ as well, but our overall cognition often is impeded by many other factors including, but not limited to, learning disabilities (like NVLD) which seem fairly common among those with these disorders. Also....I believe many with the "low-functioning autism" label also possess superior IQ. They may not do as well on the conventional IQ tests like WAIS and Stanford-Binet. If, however, they are given IQ tests like the Raven's which are wholly non-verbal and have no motor componant, many "LFA's" tend to perform in the superior, or at least, above-average range.

The discrepency between VIQ and PIQ in your case seems high enough to suggest you obviously fit the left brain dominant type. Because your verbal and language abilities are so much higher than spatial abilities, your left brain is doing a lot of work. I did not know that people with AS possessed higher than average VIQ as opposed to PIQ. But it is an interesting fact. Myself, I have always had a reasonably good spatial ability, which helps me alot at things like chess and general scientific problem solving. My verbal ability is also above average, as I tend to use a fairly advanced vocabulary in my dialogue with others. Because we contain fewer nerve fibres in the axonial cable connecting the two hemispheres of our brains, it is not unusual for men to be more dominant in one hemisphere over another , in comparison to woman. In your case, it appears to be a left hemisphere dominance. But we must be very careful about such statements, given the complex nature of the brain. As even in people with language functions lateralized in the left hemisphere, some 25% or so of the processing also occurs in the right brain (assuming you are right handed, which I am.)
As for the conclusions regarding the memory deficits involved in the block design test, I am going on basic principles as a POSSIBLE explanation. The block design likely involves a lot of spatial thinking involved, which would engage the the right hemisphere to a large degree. If there is a delay in response, then it stands to reason that performance in that would rely heavily on working memory. A deficit there could be indicative of a less than standard performance. But that is just my opinion. You will have to consult those who performed the evaluation of the results for their true meaning in this regard

It seems to me like they were trying to make absolutely sure they got only full-blown AS or autism in their study, rather than PDD-NOS (which is probably the correct diagnosis in your case, since you are evidently borderline in the AS criteria)--I can see why they did so; they want to make sure to get the "purest" possible data, and human brains just aren't all that neat and clean as to fit into boxes.

The NVLD thing makes sense to me, too. A psychologist would diagnose it as Asperger's or PDD-NOS; a neurologist as NVLD; but it's the same thing nevertheless. The way they responded to the huge VIQ/PIQ gap by stating that your full-scale IQ would be nonsensical gives me some hope for those scientists--they're not using IQ as a magical measuring stick to rank people and they're aware of its shortcomings. That's a plus. You've talked before about how variable your IQ scores seem to be; I wonder if that generalizes to everyday life--is your performance on other things similarly variable, like you can do them well one day but not the next?

Interesting... In any case, I hope the report tells you something about yourself that's useful to you.

I can only say so much about this right now. I am extremely busy as I just got back from my Pittsburgh trip and have alot of catching up to do both online and off. I had to dedicate alot time to family while I was there, so I wasn't online as much as I normally am.

Anyway.....it's hard to say whether i'm left brain dominant or not. I am left-handed when it comes to writing, throwing a ball, etc....People with AS often display a VIQ higher than people, but this is not always the case. It seems tremendously difficult to differentiate AS from NLD, but there are supposedly characteristics which are unique to these two disorders. I suppose you were referring to the corpus callosum when you mentioned the axonial cable which connects to two hemispheres of our brains

I have always scored in the average range or higher (up to the superior range in fact) on the working memory index score on WAIS. Thus....I don't believe I have any significant problems with working memory which would impact my performance on the block design subtest. Perhaps there are some other types of memory (maybe visual memory?) which would contribute to my poor performance on block design, but I really don't know anything about that. I don't recall ever reading or hearing anything about a correlation with memory problems of any sort and poor performance on the block design subtest.

More later when/if possible. Thanks for your response and insights

Thank you Awiddershinlife and Callista for your interesting, insightful and kind responses. Unfortuntely, I am very pressed for time right now as I just returned from Pittsburgh and have alot of catching up to do. Therefore, I can't respond to your posts in the manner which I would prefer. I always feel bad about posting threads like this one when I know I can't respond to everyone as quickly as i'd like, or even, respond at all sometimes. Nonetheless....this really can't be helped and the fact that i'm not the fastest typist in world doesn't help either.


Still...I greatly appreaciate your replies and the insights they contain. I read them thoroughly, albeit quickly, (i'm a fast reader) and I have many questions and comments which I wish I could post now. I will try my best to respond ASAP, but now my ex-employer asked me to work (and I agreed because I could sure use the money) a few days for him in Key West this coming weekend and I really don't know if i'll have alot of uninterrupted time online until sometime next week.

Again...thank you both for your replies and will do my best to respond to them ASAP.

I'm glad that things went well.

That is correct. I was referring to the corpus callosum. I hope this discussion helped you, even if only a minor way.

Awiddershinlife wrote:

No it certainly does not rule out a spectrum dx. The reseachers made that clear to me and it was something I knew already. As Callista already stated in this thread, I think a PDD-NOS dx would be legitimate for me but apparently, the psychs who've evaluated me do not. I've received several different Axis-I dx-es on the various neuropsych evals i've had over the years. I've been dx-ed with LD-NOS on three, Mathematics Disorder on two and nothing at all on another one. I received no Axis-I dx on the latter one because the neuropsych who evaluated me seemed pretty ignorant of NLD.

My scores (FSIQ, VIQ and PIQ) were pretty high on that evaluation...the highest i've ever received in fact. Even my PIQ was in the high average range at 111 on that WAIS. My Verbal IQ was 155 which, AFAIK, is five points away from the maximum score you can obtain on WAIS (160). These two scores yielded an FSIQ of 143, which is in the very superior range. Apparently, the neuropsych who administered this test didn't believe I could have any sort of learning disability because all my scores were too high.

While he admitted the 44 point gap between VIQ and PIQ was unusual and seen only in a very small percentage of the population, he didn't believe this was indicative of an learning disability in my case. More importantly, he failed to take my pattern of subtest scores into consideration when making my diagnosis. Anyone who knows anything at all about NLD would at least strongly suspect I have it based upon my pattern of subtest scores on the WAIS.

In all fairnesses to this neuropsych however, he did not include any of my subtest score results in the report he provided me with. Thus....I really don't how I performed on any of the subtests NLD-ers are often weak on (like Block Design and Object Assembly). I'm assuming my performance on those two subtests was similar to what it's always been...but I can't be sure. If it was....I likely scored exceptionally high on other PIQ subtests and that resulted in an overall PIQ score of 111 even if my block design/object assembly scores were as poor as they usually are. Therein lies the crux of the matter that almost every leading NLD authority has pointed out. The actual scores themselves are immaterial when trying to determine whether an individual has NLD or not. What matters, in part, is the gap between VIQ and PIQ and the really important factor is the pattern of the subtest scores.


Anyway....I don't have my report with me currently, so I can't give you the exact numbers (on the ADOS) they require to meet their diagnostic cut-offs. Nor can I give you scores I received on the ADOS as I don't recall them all precisely. I gave my report to my therapist this afternoon so she could make a copy of it. She will return it next week and hopefully i'll be able to give you all the scores then. All I can say now is that I believe they are basically looking for people who meet the textbook (per the DSM-IV/ICD-10) criteria for Asperger's and high functioning autism. This is understandable as I would likely mess up their data.




My experiences have been somewhat different at least insofar as my family and the few true friends i've had are concerned. I was the only one who knew there was something wrong with me, neurologically speaking. I knew this at seven years of age and nobody ever believed me until I finally underwent a neuropsychological evaluation at 23. Everyone just thought I was lazy, unmotivated, rebellious, etc.....It has always been one of my dreams to study neuropsychology (and psychology in general) and eventually obtain at least a Master's degree in the field. Unfortunately, I only have an AA in liberal arts. A degree which I obtained, regrettably, by opting for course substitutions for the mathematics requirement. I am now 41 y/o and I have a long and hard road ahead if I want to obtain a Master's (not to mention a Doctorate) degree in anything. I dropped introductory algebra twice since I knew I wasn't going to pass it. After that....I just gave up on math and felt that I could never be successful at it. Therefore, whether because of my learning disability and/or the memory problems I believe I have (which have never been objectively confirmed), lack of confidence, lack of motivation, or some configuration of these (and/or other factors)....I have not gone any further as far as my education is concerned. To this day.....I really have no definite idea of how far I can go no matter how hard I try. The agony that all this has caused me simply can't be expressed and I STILL have no ultimate answers in terms of what is wrong with me neurologically speaking.





This is yet another problem for me and seemingly for many other people with NVLD and AS. I come across as articulate and "quite bright" even according to one psychologist who evaluated me. Even the psychs are inclined to believe there's nothing "learning disabled" about someone with my abilities in speech, language and overall communication. I try to convince them that I have enormous challenges with visual/spatial skills/mechanical reasoning, math, memory, etc....and they just can't seem to conceptualize such things considering how erudite I seem. This is not to mention the problems I have with processing speed, psychomotor skills, executive functioning and social interaction. Thus....the so-called "illusion of competence" seems to have everyone believing i'm some sort of a genius or something who's just incredibly lazy, unmotivated, emotionally disturbed etc.....






I feel I exhibit all the "hypers" you mentioned. I do have a tremendous difficulty explaining/expressing myself (including when it comes to my emotions and this was pointed out in the report from the autism research study which was posted in my OP) and i'm always struggling to find the ideal words, expressions (verbal and nonverbal), concepts, analogies, etc....I feel as though there's another universe inside my head which no one else can ever know and which I only know very little of. I feel like I express myself better through music. Both the music of others and whatever I can manage to scratch out on the guitar. If people don't "get" what i'm trying to "say" after I tell them to listen to a certain song or whatever, then that can't be helped.





There is virtually no services worth mentioning in the United States and it's gotten even worse in recent years. OVR used to be relatively good when it comes to providing services for people with ASD's and other neurological/mental disorders. In the past 10 years or so however, OVR has faced serious budget cuts and now they're not nearly as generous as they once were. They paid for ALL my college expenses back in the late 90's....including whatever tuition which was not covered by grants, books and even parking stickers. The would've have covered all my educational costs up to a BA/BS degree. AFAIK....those days are over at least when it comes to OVR in my state.


Hmmm....i'm not sure where you're from, so you may not be familiar with OVR. OVR stands for the Occupational-Vocational Rehabilitation and it's a government agency which provides assistance (vocational, educational, psychiatric, etc....) to those with anykind of documented disability. Sorry about that....your use of the word "rotters" made me think you might be in the UK or somewhere else outside the US.

Anyway....it now seems like all OVR will do is provide vocational assistance. They will take you as you are and not offer to assist with any further training, education, etc....They will send you to employers they have under contract and even if these employers are offering nothing but low-wage, unskilled and dead-end jobs....they will then pronounce you a "success story" and move on to the next disabled client. You see....we're too busy in America to help the disabled. Fighting unnecessary /immoral wars and giving tax cuts to millionaires is a far bigger priority obviously





Hmmm.....now this is VERY interesting. Herein lies several oddities where i'm concerned actually and once again....a few things just don't add up. There may be readily available answers for the things i'm referring to, but I just don't have them. First of all....if there is a moderate association between the HRT and the MRT, it might not apply in my case. I have always scored between low average and superior on the MRT. I've taken the Halstead-Reitan before (or at least one of the seven or eight subtests on it) and I scored in the <1st% (impaired...of course) on the Category Test on the HRT. Now I don't know if the Category Test ITSELF on the HRT measures the same skills as the Matrix Reasoning subtest supposedly does. Thus....I cannot determine whether this "moderate association" (if that is valid in the first place) between the HRT and MRT has anything to with the category test on HRT per se. Perhaps it does, or maybe this "moderate association" has more to do with the other measures on HRT. I could speculate further about all this...but that would be fairly pointless at this juncture.

Nonetheless....there are other things to considered when it comes to the category test and my poor performance on it in particular.


The following excerpt is from the book "Neuropsychological assessment of neuropsychiatric and neuromedical disorders". It may provide some insight into the memory problems I believe I have:


"The Category Test is probably the best measure in HRB of abstraction, reasoning and logical analysis abilites which in turn are essential for organized planning. As noted earlier, subjects who perform especially poorly on the category test often complain of having "MEMORY PROBLEMS" . In fact, the category test requires organized memory (as contrasted with the simple reproduction of stimulus material required of most short-term memory tests) and is probably a more meaningful indication of memory in practical, complex, everyday situations than most so-called memory tests especially considering that in a purposeful, behaviroal context necessarily depends on relating the various aspects of a situation to each other".

I certainly do "complain" of memory problems which it would be difficult for me to elaborate on now. Suffice it to say that they've never been objectively confirmed, but there is little doubt that people can have severe memory deficits (particularily when it comes to long-term/very long-term memory) which simply elude detection on the standard neuropsychological memory tests. Even the neuropsychologist who just evaluated me agreed with me about this. Nonetheless...he said nothing about a correlation between the memory problems I believe I have and my poor performance on the category test. Rather....he said that those who perform poorly on the category test are usually bad at math. Well....I certainly am bad at math, so i'd say the category test is accurately measuring SOME of the weaknesses I have.

Also.....the neuropsychs who've evaluated me always claim my abstract reasoning abilities are superior and the category test, according to the excerpt above, is a good measure of abstraction. So here again we have some incongruity which I don't have a great answer for. I recently took a Watson-Glaser critical thinking test at a career-vocational assessment center OVR sent me to and I scored in the 97th percentile on it. The examiner claimed it was the highest score he had ever seen. I believe there's alot of abstract reasoning involved in critical thinking, so I really don't know if the category test says anything about my abilities in abstract reasoning.

I'm not sure why they're claiming the MRT is significantly associated with verbal abstract reasoning, verbal fluency, etc....If you can elaborate on that a bit, I would appreciate it. I was always under the impression it was a purely nonverbal test which measured nonverbal reasoning and pattern recognition. Actually....with this in mind...the category test on HRT might just measure NONVERBAL abstract reasoning and the authors of the above excerpt just weren't specific about that. There is every reason to believe my NONVERBAL abstract reasoning could be deficient, or even, impaired.





Many of my neuropsychological evals suggest that I probably do have frontal lobe deficits. I believe these may have been indicated by my performance on the category test and the HRT in general. The HRT is supposed to be one of the most sensitive instruments when it comes to detecting brain damage/neurological impairments. It won't necessarily identify the precise region/s of the brain affected, but it does supposedly pick up on neurological impairment in general. I'm not sure how my neuropsychs came to the likely conclusion that I have frontal lobe deficits, but I would guess it had something to do with my performance on HRT and/or the category test in particular and this was possibly coupled with my performance on tests like block design. I do have significant problems with processing speed and psychomotor skills and these too can depress one's performance on block design considering it's timed and has a motor componant.






I'd say this is highly questionable when it comes to those with AS specifically. Many people with AS obtain very NLD-like scores on their IQ tests. I've heard conflicting statistics about this....but supposedly as many as 80% of those with AS exhibit the typical NLD pattern of performance on IQ tests. Perhaps at least some of the AS individuals Firth was referring to were misdiagnosed with AS and have HFA instead? Anyway...i've also heard that only about 25% of those with AS display the common NLD pattern of scores on IQ tests, so I really can't say anything conclusive here. Block Design is typically one of the lowest subtest scores for NLD-ers, that much is certain.






It's defined by social and motor skills deficits as well. Executive functioning deficits are also pretty common in NLD and sensory issues can be present as well. There are plenty of people here with some kind of visual-spatial deficits who have been dx-ed with AS.

Therefore....I wish you the best of luck differentiating AS from NLD/NVLD, because I sure as heck have problems with that!! !

Anyway.....excellent post....thanks alot for the insight

Well....they didn't really....but that's another story. I am alive and physically well AFAIK and thus... I am not entirely without hope.

Thanks nonetheless Cockney!! !

Hmm. I have little to say that you couldn't guess for yourself (I find your reaction interesting; you let the comment that you're in the 96th percentile slide, but make a face at the comment that you're in the 14th).

Excuse me if this sounds rude, I don't mean to accuse you of lying, but did you falsify some of your personal information? Some of it seems implausible.

Callista wrote:

That's precisely what they were trying to do although "low-functioning" (per their criteria) individuals would be ruled out. I fully understand why they rejected me and it's not as though I feel butthurt or anything. That would be ridiculous of course and I understand that i'd probably foul up their data. I just feel quite disappointed since I was looking forward to anything the neuroimaging studies MIGHT be able to tell me about the memory problems I believe I have. While the neuroimaging in this study would've been fMRI's....I believe structural whole-brain analysis images would be available as well. They likely would not be available to me UNLESS some gross abnormalities were indicated. Still...if any of the memory problems I believe I have are the result of gross neurological abnormality/s, they surely would've told me about them.

I agree with you that PDD-NOS is probably the correct diagnosis in my case. Nevertheless i've never received that dx and i'm not quite sure why. I definitely exhibit most, if not all, the "classic" signs of NLD and since many neuropsychs tend to view NLD as a "milder" version of AS, a PDD-NOS dx would seem warranted rather than the LD-NOS or Mathematics Disorder dx-es i've always received. Coupled with schizoptypal/schizoid personality disorder though, I guess the LD-NOS/MD dx-es are fairly valid in my case. I'm wondering if the reason I haven't received a PDD-NOS dx is because I don't exhibit any atypical symptomatology. I DO obviously exhibit subthreshold symptomatology however. IOW...my symptoms are supposedly mild rather than atypical for AS or ASD's in general. Subthreshold symptomatology should be enough to make a PDD-NOS dx I guess, but i'm really not sure.

I did display some difficulties with reciprocal social interaction on the ADOS, but they were not significant enough to meet the diagnostic cut-offs for autism or ASD's in general. Even if they had been, I doubt I would've met their cut-offs on the ADOS because all my other measures (communication, stereotyped/repetitive behaviors, routines, interests, etc....) were not even close to their diagnostic cut-offs on ADOS. The ADI-R is a whole other story however, but I guess that is not the final determining factor in terms of whether one meets their criteria or not.

Like I said earlier....I think my mother might have exaggerated my symptoms when she performed the ADI-R with them back in June. She knew how bad I wanted to get accepted into this study, so she might have done this in spite of the fact that she adamantly denied it. Also......her memory of my behavior over 35 years ago is probably not very reliable.


Another interesting thing was my performance on the imagination/creativity section on the ADOS. I obtained a score of 1 and the minimum score required for those with autism and ASD's was not available. Apparently, this is a low score on imagination/creativity and i'm somewhat disturbed about that too. While i'm hardly the most imaginative/creative person in the world, I don't think i'm the least either.






Obviously most psychologists won't make an AS/PDD-NOS dx for many of us with NLD. If our symptoms commonly associated with AS aren't textbook, they just rule it out. I've been saying it's the same thing for a long time now. At least in terms of a common, or very similar, neurological etiology for NLD and AS. The diagnostic hair-splitting between these supposedly distinct disorders is getting a tad obnoxious IMO. Check out the chart in Yvonna Fast's article and I think you'll find several glaring inaccuracies though I suppose they could be mere typos. Scroll to the bottom of the page if want to see the chart.

http://www.nldline.com/yvonna.htm


For one example....those with NLD "rarely" have problems with spatial skills ("knowing where an object is in space in relation to other objects") while those with AS "mostly" have these issues? Again...it's very possible this is a typo, but that certainly would be contrary to everything i've ever heard about NLD and spatial skills.


I was pleased with their response about the VIQ/PIQ gap as well. Furthermore....I was almost CERTAIN you out of all people on WP would make some positive remarks about this since you've always been so empathic in regards to the foolishness of considering the FSIQ score when there's big discrepancies between VIQ/PIQ. To be fair to the neuropsychs/psychs who've evaluated me over the years, most said something similar to what the researchers in this study said. They did report my FSIQ nonetheless (standard operating procedure i'm sure), but they did acknowledge the fact that it was meaningless in my case.

You asked a very good question here and i'm not sure if I can answer it with any degree of confidence. For some reason, i'm not very conscious of how my skills may vary from day-to-day. Still....I do believe my performance on many things varies from day-to-day. The best example I can think of off the top of my head is my guitar-playing.

While I don't think any of the WAIS subtests would measure the skills involved in playing the guitar, I think most, if not all, aspects of cognition can vary considerably from day-to-day for a whole host of reasons like diet, sleep patterns, stress levels, anxiety, depression, etc....Guitar playing mostly involves motor skills and memory....probably procedural memory most notably.


As as interesting side note however...there is some evidence to suggest that procedural memory might be deficient in those with ASD's. If so...it has also been suggested that those with ASD's who have procedural memory issues may compensate for them via declarative memory (in the case of guitar-playing, that would probably be semantic memory specifically). I do believe I have problems with procedural memory whether they are associated with NLD/AS/PDD-NOS or not. I do have objectively confirmed and rather significant problems with psychomotor skills and these definitely impede my skills on the guitar. Anyway....some days my playing is really crappy and the next day it might be substantially and comparatively better.



I wouldn't say the report told me anything really useful in any practical sense, but i'm not sure about that either. For one thing....I now have some objective confirmation for my difficulties at expressing how I feel when i'm happy, (which is rare unfortunately...but I think my depression has subsided a bit thanks most likely to the 60mg of Celexa i'm taking everyday), sad, angry and anxious. This has always been frustrating to me and i'd like to learn how to express my emotions better. I think I may be able to express them better both verbally and nonverbally.

Actually I could guess that for myself. I felt someone would come along and try to tell i'm viewing the glass as half-empty and i'm not surprised you were that person. Now it certainly doesn't make me think less of you, I think you and most folks on WP are the cat's meow

Still....I believe there is a huge gulf between your worldviews and my own. Mine do tend to be quite negative/pessimistic (though I view them as realistic...but that's another story) and your own seem rather sunny and optimistic.

At any rate....I simply can't tolerate the thought of any sort of cognitive shortcomings. I can easily tolerate the thought of them in others and if they can accept them....more power to them. I wanted to be nothing short of omniscient and omnipotent and believe it or not...I think this is a fairly natural aspiration for most, if not all, human beings.

Were this not so....why would millions, if not billions, of intelligent, relatively sane and decent people be attracted to things like mysticism and occultism? After all...what is the ultimate goal of the mystic/occultist? Is it not unification with the absolute, the all, the infinite, "god", etc.....???

Thus.....I have my own desire to reach the exalted grade of Ipsissimus and I believe optimized/ideal cognitive functioning is a critical part of that.

Haha....I can't tell if you're being sarcastic or not. That's a good one if your intention was to confuse me in this regard. I feel like an idiot even saying that of course I falsified some of my personal info. Were you trying to determine whether i'm actively delusional and psychotic or something??? As nice as being the crowned and conquering child of the Aeon may be....I don't actually believe i'm Horus or something. Perhaps the suffering reincarnation of Aleister Crowley who is atoning for the many sins of his last lifetime....but not Horus himself


Now I don't actually believe that either...but you never know eh?


How's that for a classic schizotypal idea of reference???

Sorry....I just never heard anyone refer to the corpus callosum in that manner. The discussion has helped....the more insight into my very mysterious brain...the better.