Back from the Neurologist - I'm official for the 2nd time

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I just had my follow-up with the neurologist here in Boston. Most of the neurological testing was pretty normal. IQ is described in the "superior range" (93rd percentile) and there didn't seem to be any disparity between verbal and non-verbal.

I wasn't surprised that motor skill turned up to be slightly inefficient or the fact that my memory seems to degrade much less than for most people (long-term memory) as those are common with AS.

I was actually somewhat surprised to hear that I have no apparent deficit in executive function or face recognition (although working memory and executive function fell in average range as compared to most competencies being elevated). Executive function surprised me because of knowing how distracted I am much of the time (although that is often due to hyper-focus). Face recognition surprised me because it "felt" difficult when I took the test, but he said that in particular my memory for faces didn't degrade much.

The MMPI-II he gave me for personality assessment showed "a good degree of social naivete" (duh).

I'm assuming there's absolutely nothing shocking about that paragraph from the personality section of the neurologist's report. Hence the reason why WP is named WP.

It seems however that the majority of the consensus for the AS diagnosis (which he did recommend in his report), came from a tool I hadn't heard of before called the Gilliam Asperger's Disorder Scale (GADS), which he completed via interview about my childhood with my mother. Though he did say that the GADS tool is normally limited to a particular age range (he said 18, but the info I found says 22) and since I'm at least 10 years older than the normal age limit, the result of the GADS can't be used as an actuarial tool (i.e. definitive answer). So he didn't calculate a score on GADS for my symptoms because of that, but it was used as a clinical tool and he said that's where he found the bulk of the support for a diagnosis of AS.

My problem with jobs is described as "chronic occupational problems". But in general it appears to be just the AS and the problems caused by the AS - DSM-IV Axis I - 299.80 Asperger's Disorder - nothing in either Axis II-III - job problems in Axis IV.

In Axis V he described my condition as 50 (serious symptoms) which seems right... examples describe inability to keep jobs http://ivy_league0.tripod.com/rhyme_of_ ... /id19.html

He suggested that I try for temporary disability during vocational rehabilitation as the next step prior to potentially declaring me permanently disabled if that doesn't work, but he didn't feel permanent disability would be likely in my case.

So long story short basically the neurological testing confirmed pretty much everything I already knew from both self-diagnosis and from the psychologist's diagnosis last year in Oregon. It is rather a load off my mind though, since I was self-conscious and concerned that the report would say I appeared normal. I pretty much knew that fear was unfounded, but that didn't keep me from being anxious about it anyway.

So... I guess now we'll see how things go when I get back to Texas this month and start talking to attorneys and voc rehab.

Wish me luck!

Oh, so neurologists can diagnose such. Neat. I thought it was the realm of a neuropsychiatrist or something.

Honestly I would have been fine with just the psychologist's diagnosis I'd had from Oregon last year, but I got the neurological testing for two reasons. First to rule out other potential issues going on that I might not have been aware of and also because I'm looking at dealing with legal issues related to child-support and the psychologist here in Boston told me that the state would probably want neurological testing to back up the psychologist's report.

The neurologist actually mentioned during this follow up that he really feels that the work for my diagnosis could have all been done by the psychologists without the benefit of the WAIS-III or other neurological testing, but that he's often asked to do the neuro testing anyway just because different people (like attorneys) want it for one reason or another, even though it may not be terribly relevant.

If it weren't for the legal issues I might not have bothered to get a diagnosis at all... but it is kind of comforting to me to know that my self-diagnosis was pretty accurate and that as frustrating as life has been for me thus far, my case isn't terribly complicated as it is for some of the folks here who have other contributing issues like ADHD or mild schizophrenia as comorbidities.

Well, I'm seeing a neurologist for a plethora of issues. It's just interesting to note that the neurologist might have a chance to legitimately diagnose me before the neuropsychiatrist gets to. Mind you my appointment weth the neurologist is 4 hours before the neuro-shrink... so...

I think it's really a great thing that you stuck this out to the end and congratulate you for doing so. It's just a start you know on a long road. I know that you already know that. Now you have the things you need to go forward, at least for a while but now the rest will be far easier than it used to be.

Thanks Gary, your support is very much appreciated.

with the executive function and face recognition stuff, presumably you're tested in a quiet environment with no distractions and you have plenty of time to stare at faces - in life it's not like that so I think those sorts of results can be skewed by the fake environment and extra time of a clinicians room.

anyway, congratulations, if that's the appropriate word.

Who said you get extra time?? where do you get this stuff from.

? well there's lots of face recognition tests online, they consist of staring at a photo for as long as you like until you pick one of a multiple choice selection on which emotion the face is showing or whether you have seen that face before (some tests are for reading the 'mood' of people in their facial expressions).

I'm presuming he did something similar although I could be wrong. In life you can't just stare at people for as long as you need to decifer their emotional state or to recognise them, it's meant to be done instantly. It also doesn't often happen in a quiet enviroment with no other distractions.

Well the way that kind of influence is "ruled out" in the report is that your scores on the laboratory test are only compared against the scores of other people on the same laboratory test.

In the face recognition test as an example, he flips over a series of images and asks me to remember them, but, I don't get to control the speed. (Would be better on a computer, because the computer could rigidly control the speed.) The pages get flipped at a rate of about 1 every 2-3 seconds. (He's not rushing to flip them, but he's not spending much time per image either.) So whatever deviation shows up is only with respect to the prescribed amount of exposure (and number of images shown) and apparently I scored fairly average in that department. So that test actually makes it harder to remember them in that case, because in real life situations with people I work with or hang out around, I generally have more than a couple seconds exposure to their face.

Executive function is handled similarly, although again, imo it would be better for a computer to control the input. I believe most of the executive function tests were delivered verbally.

Ahh, well that test wouldn't give very strongly correlated results then.

Post, Keep in mind that the 'Internet' is not the real world.

naw, your'e kidding me!

When I was given the Benton Facial Recognition test (by a psychologist, not online), it wasn't particularly like real-world situations. It sounds like you had a different one though. With mine, it was something like I was shown one face up above, with four faces below it and I just had to choose which of the four matched the one above. So it was recognition they were looking for (hence the name of the test I guess), rather than recall. I think the test is meant to screen for prosopagnosia, rather than look for more subtle problems with facial memory (not that I think I have such problems anyway). Someone with prosopagnosia probably would not have been able to recognize a face like that, even with the matching face right in front of them, so I guess the test looks for serious deficit. Probably someone with those issues could compare faces feature by feature if they had learned that as a compensatory technique, but I suspect that it would take them so long that their performance would be clearly abnormal.

I also had a couple tests of executive function. By and large, I did fine on the tests designed specifically to measure attention, which is interesting given that 3 different psychologists have told me they think I have ADHD. However, I did terribly on a test of auditory memory (ranging from moderately impaired to average), and the psychologist said that she thought that was due to my attention "waxing and waning." I hadn't been aware at all that my attention was apparently "fluctuating," but she said that that is what it seemed like to her. Anyway, I think my problems with attention/executive functioning are part of NLD rather than being strictly ADHD, and a difference between NLD and ADHD that I've read mentioned in the literature is that in ADHD it is difficult to sustain attention, while with NLD the problem is figuring out what to attend to. That would actually fit my performance on the auditory memory task, since at the beginning of each test section I would perform in the moderately impaired range, and then throughout the repeated trials my performance would move up to average. Then as soon as the test format changed, I would fall back into the moderately impaired range. Maybe I just needed some extra time to focus my attention properly. That was probably also why I was able to do well with the tests designed specifically for attention- because the stimulus I was supposed to be attending to was unambiguously right in front of my face.

So basically what I am trying to say is that testing conditions are not real-life conditions (in real life, I *do* have problems with attention), because the testing room is quiet and there are few to no distractions, like Postperson said. Also, the test stimuli tend to be unambiguous and "in your face" so that you don't have problems filtering relevant from non-relevant information like you do in a normal environment. Plus, even people with ADHD may be able to focus with intense effort during the time needed for the test. Good psychologists (and other kinds of therapists like speech language pathologists) are aware of this, however, which is why they take into account subjective accounts of people's experiences.

Thanks by the way, I neglected to say that before.

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