Questions about NVLD/Wechsler Memory Scale, etc...

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Horus
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18 Sep 2009, 7:04 pm

In my thread entitled "A rare and crippling memory impairment AND NVLD", I said I believe I have a serious Long-Term memory impairment specifically involving my semantic and procedural memory. I also said i'm basing this belief SOLELY on my own self-observations over a lifetime. NONE of the memory tests I was given on any of the four full neuropsychological tests i've taken indicate this. My scores on the Primary Indexes of the Wechsler Memory Scale were all between average and superior. Ditto for the Primary Subtests....all between average and superior. Does anyone know if the Wechsler Memory Scale gives an accurate and complete measurement of an individual's semantic and procedural memory? If so...which indexes/subtests on the WMS are designed to specifically measure one's semantic and procedural memory? All I know is what little i've read about it. The WMS-III (the edition I was given) is supposed to provide a "comprehensive assessment of memory". Needless to say, that means the test does assess Long-Term memory and I suppose that also means it measures both semantic and procedural memory which falls under the umbrella of LTM. Is it possible that the WMS could somehow overlook some very significant and crippling impairments in memory...again...semantic/procedural in my case? For whatever reason/s, can the WMS results be unreliable and/or incomplete when administred to those with NVLD/AS/ASD/PDD, etc...? That is......does this test tend to underestimate/overestimate the memory functioning of those with the aforementioned disorders? If so...are any of the Indexes/Subtests on the WMS which are particularily unreliable/incomplete in the case of people with NVLD, AS, etc....?


If the Wechsler Memory Scale leaves something to be desired in terms of offering an accurate and complete assessment of a person's (neurotypical or otherwise) semantic and procedural memory, then are there any alternative memory tests which are superior in this regard?
Are there any that would be better at determining the semantic and procedural memory of those with NVLD and/or autistic spectrum disorders?


The Woodcock-Johnson Test of cognitive abilites was included on one of the four neuropsych tests I took.....I DID obtain a score of 91 (28th percentile/3.2 Grade Equivalent) on the, "Memory For Names" subtest. But on the same test....I scored 122 and 107 respectively on the "Memory for Sentences" and "Memory for Words" subtests. 122=93rd percentile/16.9 Grade Equivalent and 107=equals 69th percentile/16.9 Grade Equivalent.

In the "test interpretation" comments of this particular neuropsych exam, the following was said:

"M is showing a weakness in fluid ability, or ability to solve new problems where neither formal schooling nor acculturation facilitate task performance. This weakness was confirmed by results of the WJ-C (Memory for Names=91; Fluid Reasoning=88). In addition, he is showing a relative weakness in computational ability that was also confirmed by results of further testing (WJ-A Broad Math=93) On the WJ-A, a measure of school achievement, M is achieving at a level commensurate with his level of formal education in reading and writing. However, he is achieving significantly below expectations in mathematics. A review of his errors in mathematics reveals M is able to solve the basic functions of addition, subtraction, multiplication and division. However, he is unable to manipulate more difficult problems involving fractions or to solve algebra problems. In general, M's cognitive and achievement test results fit the pattern found in students with nonverbal learning disabilities".


Okay...well... ALOT of people with NLD characteristics exhibit the same, or very similar weaknesses, in "Fluid reasoning"/the ability to solve new problems/novel material? The trouble is....MOST people with NLD don't function anything close to my abysmal level. They might have some significant struggles, but most seem to be able to complete their college educations, live independently, obtain decent-paying skilled positions, etc...In those cases...."weakness" doesn't seem to be synonymous with total incapacity. In my case...it does. Now people with NLD characteristics AND FSIQ scores of less than 85 or something likely do function around my level. I've never obtained an FSIQ under 112 (high-average) or even a PIQ score under 94 (my PIQ score was 100, 102 and 111 on the other tests) My VIQ scores are 119, 125, 127 and 155 respectively. So yes....if a person *has* NLD and IQ scores which are substantially below-average then it would perfectly understandable if they were functioning at my level....but what's MY excuse? Hopefully some of you can see why i'm so confused by all this.

They also said my, "pattern of strengths and weakness on the WAIS-III revealed a significant strength in crystallized ability, or factual learning that is dependent on formal schooling and acculturation".

Okay...fair enough...so how could I have a problem with semantic memory IN GENERAL if I possess "significant strength" in crystallized ability/factual learning? Factual learning is highly dependent on semantic memory right? Does my supposedly (according to this particular test) poor "memory for names" just mean that my ability to solve new problems hits a ceiling at some level? All "problems" are new at some point, so how is it I could aquire "significant strength" in crystallized ability/factual learning in the first place? Furthermore, this particular neuropsych test did not include the Wechler Memory Scale-III. The test that did was the one I mentioned previously in this post where ALL my Indexes/Subtests results on the WMS-III were between average and superior. No substantial memory problem was indicated on that particular test and wouldn't one of the Indexes/Subtests on the WMS correspond to the "Memory for Names" subtest on the Woodcock-Johnson Test of cognitive abilites?

The most recent neuropsych test I took also included a WMS-III. The results were not broken down individually on that one, but neuropsych who administred the test said my results ranged from high average memory for verbal information and low average scores in non-verbal memory. The confusing and conflicting results of the memory tests on these three neuropsych exams is driving me insane!! ! I know what I PERSONALLY think about my own memory and at least in terms of semantic and procedural memory, I think it's profoundly impaired. But even the worst results I obtained (with the possible exception of the "Memory for Names" subtest on the WJ-C) suggest that I might be grossly overestimating my own memory problems.

Since my "Memory for Names" subtest score on the WJ-C entails a Grade-Equivalent of 3.2...does this mean i'm not able to learn/memorize many, if not most, things beyond a third grade level? If that's the case, why I am I able to write as well as I do? Furthermore, the psychologists who tested me KNEW I was in college at the time, so if my "ability to solve new problems" is/was so weak, why didn't they tell that I wouldn't be able to handle college-level material? In fact.....they told me I might STRUGGLE with college-level coursework, but that I ultimately possessed the capacity to handle it. If i'm that much of an idiot, how did I manage to obtain a FSIQ score of 143 on the last WAIS-III took? Sure the notorious "gap" (VIQ-155/PIQ-111) common among people with NLD was present on that test, but it was present to some degree (though this 44 point gap was the widest one I ever obtained on any of the four WAIS tests) on every WAIS test i've taken.

If, as this last test would suggest, i'm so smart....then why in god's name do I LITERALLY function at the level of someone with either mild retardation or borderline intellectual functioning? My level of functioning has NEVER been any greater in all my 40 years. Why have I never been able to live independently? Why have I never been able to handle anything beyond the most menial job (waiting tables, retail sales, dishwashing, convenience store clerk) and why have I had trouble with certain tasks (like operating a cash register) even in these menial jobs?

Why do I have absolutely NO skills whatsover, vocational or otherwise? The "whys" could go on and on yet EVERY stinking psychologist who ever tested me claims I DO ultimately possess the capacity to handle college-level coursework, obtain a skilled occupation, etc.....I really can't stand this mystery that is my brain anymore!! ! I can't think of one reason why i've always functioned at the level I do if I actually have the capability to do much better. If that's the case, then it would seem to suggest that I *somehow* WANT to function on this level. Talk about something which would opposed to one's rational self-interest!! ! If I somehow want to function on this level, then I sure don't want to consciously and i'd have to delve into my subconscious for that answer.

Or maybe these neuropsych exams and those who administred them *somehow* grossly overestimated my abilites. I know it's possible for IQ results to be under-inflated but over-inflated? Over-inflated to the EXTENT mine have been? Over-inflated on FOUR seperate tests?? I just wish to god there was somewhere I could go to get a clear, final and indisputably accurate assessment of my neuropsychological problems. I can't afford even another on-paper neuropsych test right now though and what would be the point of that even if I could? I'm sure the results wouldn't be THAT much different than all my previous ones and i'd learn nothing other than what I already know. All these years of seeking, testing and researching and I STILL feel I don't know anything more about my fundamental neuropsych problems than I did when I began the quest to unravel the mysteries of my unspeakably bizarre, incongruent and idiosyncratic brain!! !



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18 Sep 2009, 8:37 pm

Can you give practical examples of how you have difficulties? You write so concisely it's hard to tell that you struggle. For instance if you were in a university setting, what would be your pitfalls?How about a business office?



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18 Sep 2009, 9:16 pm

Well, I don't know much about the WMS-III in particular, but I am dx'ed with NLD as well, and am also a speech therapist who is familiar with a few memory assessments.

Horus wrote:
For whatever reason/s, can the WMS results be unreliable and/or incomplete when administred to those with NVLD/AS/ASD/PDD, etc...? That is......does this test tend to underestimate/overestimate the memory functioning of those with the aforementioned disorders? If so...are any of the Indexes/Subtests on the WMS which are particularily unreliable/incomplete in the case of people with NVLD, AS, etc....?


As I said, I don't know the WMS-III specifically, but it seems extremely unlikely that it would over-estimate the memory abilities of people with NLD- it seems more likely that they would be depressed (which is often what happens to those with LDs when they take formal tests). NLDers tends to have strengths in semantic memory, so I suppose if the WMS-III *only* looked at semantic memory, it might overlook some very real memory deficits in other areas, but it doesn't sound like that is the case. Or alternately, if the test only looked at auditory memory (usually strong in NLD) and not visual memory (usually weak in NLD), it might overestimate the abilities of NLDers, but again, it does not sound like this is the case.

Quote:
If the Wechsler Memory Scale leaves something to be desired in terms of offering an accurate and complete assessment of a person's (neurotypical or otherwise) semantic and procedural memory, then are there any alternative memory tests which are superior in this regard?


Like I said, I am not familiar with the WMS-III, but as a comprehensive test of memory, I am fond of the Rivermead Behavioral Memory Test (RBMT-3). I find it to be extremely sensitive- if there is suspicion of a memory difficulty, the RBMT *will* pick it up.

Quote:
The Woodcock-Johnson Test of cognitive abilites was included on one of the four neuropsych tests I took.....I DID obtain a score of 91 (28th percentile/3.2 Grade Equivalent) on the, "Memory For Names" subtest. But on the same test....I scored 122 and 107 respectively on the "Memory for Sentences" and "Memory for Words" subtests. 122=93rd percentile/16.9 Grade Equivalent and 107=equals 69th percentile/16.9 Grade Equivalent.


Looking at percentile scores and grade equivalents is usually misleading unless you know what you are doing. In fact, a standardized score of 91 is actually "low average," meaning that you scored within the average range of scores. So that score would not actually indicate memory impairment, just perhaps a relative weakness for remembering names, given your other scores.

Quote:
Okay...well... ALOT of people with NLD characteristics exhibit the same, or very similar weaknesses, in "Fluid reasoning"/the ability to solve new problems/novel material? The trouble is....MOST people with NLD don't function anything close to my abysmal level. They might have some significant struggles, but most seem to be able to complete their college educations, live independently, obtain decent-paying skilled positions, etc...


I would disagree with that. Many people with NLD have significant problems obtaining or retaining even "menial"-type work, and have significant problems with independent living. The rates of unemployment are even higher among people with AS.

Quote:
All "problems" are new at some point, so how is it I could aquire "significant strength" in crystallized ability/factual learning in the first place?


Problem-solving/reasoning is not the same as memory. People with NLD often have superior semantic memories, while having great difficulties with fluid reasoning, so there actually isn't a contradiction there.

Quote:
The most recent neuropsych test I took also included a WMS-III. The results were not broken down individually on that one, but neuropsych who administred the test said my results ranged from high average memory for verbal information and low average scores in non-verbal memory.


That definitely sounds like NLD. My memory for verbal written information is actually in the "very superior" range (auditory recall is not great though due to attention issues), but my recall for visual material is in the mildly-moderately impaired range (per the Rey Osterrieth Complex Figure Test). Even when I am given basic visual images to remember and I consciously use verbal mediation strategies to boost my recall, I still fall outside of the average range. That kind of verbal-visual difference is very typical of NLD.

Quote:
Since my "Memory for Names" subtest score on the WJ-C entails a Grade-Equivalent of 3.2...does this mean i'm not able to learn/memorize many, if not most, things beyond a third grade level?


Again, those "grade equivalent" scores are really not very useful to look at- people see them and think that they actually performed much worse than they did (in fact, in graduate school they told us not even to include that information, as it is misleading). Your score of 91 actually did fall within the average range, albeit the lower end of it.

Quote:
If, as this last test would suggest, i'm so smart....then why in god's name do I LITERALLY function at the level of someone with either mild retardation or borderline intellectual functioning? My level of functioning has NEVER been any greater in all my 40 years. Why have I never been able to live independently? Why have I never been able to handle anything beyond the most menial job (waiting tables, retail sales, dishwashing, convenience store clerk) and why have I had trouble with certain tasks (like operating a cash register) even in these menial jobs?


That honestly is not uncommon for people with learning disabilities- because part of your brain actually *is* functioning at a mentally impaired level. And cash registers are actually typically tough for NLDers (based on what I've read)- I can also vouch for this based on personal experience! Using a cash register requires decent procedural memory, fine-motor skills, and calculation (for giving change), all of which NLDers tend to struggle with.

Quote:
Why do I have absolutely NO skills whatsover, vocational or otherwise? The "whys" could go on and on yet EVERY stinking psychologist who ever tested me claims I DO ultimately possess the capacity to handle college-level coursework, obtain a skilled occupation, etc.....I really can't stand this mystery that is my brain anymore!! !

This actually is a common complaint among those with NLD and AS- most psychologists and vocational counselors are not equipped to deal with the unique set of strengths and deficits people with those conditions possess. They can place people with mental retardation without difficulty, but often have difficulty anticipating the problems someone with NLD or AS might face on the job, and thus have difficulty choosing appropriate placements. My advice is to get in contact with a place that specializes in learning disabilities, either a vocational office or something else, and see if they can make any suggestions.

Quote:
Or maybe these neuropsych exams and those who administred them *somehow* grossly overestimated my abilites. I know it's possible for IQ results to be under-inflated but over-inflated? Over-inflated to the EXTENT mine have been? Over-inflated on FOUR seperate tests?? I just wish to god there was somewhere I could go to get a clear, final and indisputably accurate assessment of my neuropsychological problems. I can't afford even another on-paper neuropsych test right now though and what would be the point of that even if I could? I'm sure the results wouldn't be THAT much different than all my previous ones and i'd learn nothing other than what I already know. All these years of seeking, testing and researching and I STILL feel I don't know anything more about my fundamental neuropsych problems than I did when I began the quest to unravel the mysteries of my unspeakably bizarre, incongruent and idiosyncratic brain!! !


My best guess, and bear in mind I am making this guess based *solely* on reading a couple of your posts so take it with a grain of salt, is that semantic memory is not your primary area of difficulty. You would be surprised at the types of deficits that can masquerade as memory deficits. For example, I've had multiple patients tell me that they have difficulties with memory, when in fact they have trouble with with attention- they are not properly processing the information in the first place. Someone with problems with mental organization may have trouble retrieving information that actually is stored away in their brain. Or if someone has increased difficulties with a certain type of task, for example due to a learning disability, it may take so much effort simply to get through it (for example, imagine someone with dyslexia reading a paragraph in a textbook) that not much mental energy can be spared to store it into memory. These are not really examples of memory deficits, but they will certainly *appear* to be related to problems with memory. So it is possible that something similar may be going on with you. But that's just a guess based on what you've said about your normal scores on memory tests.


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19 Sep 2009, 2:21 pm

Aimless and LIS,


I am sorry I haven't responded to your posts yet. There are so many things i'd like to say/ask and I just don't know where to begin right now. My situation is inexpressibly complex and I really don't know how much longer I can go on. I'm not saying i'm contemplating suicide, I am obviously too much of a coward to kill myself regardless of how bad my life is. Even if it gets worse, I can't envision ever being able to take my own life. Nevertheless, I really don't know how much more of this psychic torture and stress my body can endure. I think my heart might just give out soon from it all. I am all-but completely dysfunctional right now. I haven't even eaten for three days, I just can't muster the desire to do so. The circumstances of my life are worse than they've ever been and it's very likely they're about to get far worse still. So again, I am very sorry I haven't gotten back to you guys yet. I am just too overwhelmed at the moment, but I will try to do so ASAP.



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19 Sep 2009, 2:30 pm

That is quite alright. You will probably feel better if you force yourself to eat a little something. Low blood sugar can't be helping the situation.



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19 Sep 2009, 3:44 pm

Aimless wrote:
That is quite alright. You will probably feel better if you force yourself to eat a little something. Low blood sugar can't be helping the situation.




I might try to eat something tonight....though eating ITSELF is a burden. I know that sounds preposterous and I don't expect you to understand. No one save myself can truly understand. Even I don't fully UNDERSTAND my own personal hell, I just know how I FEEL better than anyone else can. Eating has never made me feel any better psychologically speaking. For whatever reason/s, (changes in Seritonin levels or some other neurochemical/psychological cause) I usually feel noticeably and relatively more at ease and *less* depressed as the evening progresses. The mornings and afternoons are when I feel my absolute worst...it's always been that way. Needless to say, the only time I feel no pain is when i'm asleep. I have no quality of life whatsoever, though there were times that I at least FELT like I did. I can't stand anything about myself....most rationally self-interested and remotely courageous people would've killed themselves along time ago if their circumstances were even close to as bad as mine. I am an unjustifiable burden on myself and everyone else. Well...nothing else to say right now....i've said enough meaningless and unhelpful nonsense already.



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19 Sep 2009, 9:01 pm

I'm sorry things are so rough for you right now, Horus. Have you considered staying with a friend for a few days? It might be nice to have companionship, and they could provide some food for you (since you *do* need to eat at some point), which is easier than having to get it together yourself. Another person might be able to distract you a bit, and also might be able to get you doing something, even something simple like taking a short walk. I know it probably feels impossible to do anything at this point, but if you can just make yourself do something- anything- it'll be better than lying there feeling miserable.


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19 Sep 2009, 10:11 pm

I have AS, NLD and memory problems.

It is hard for me to accept that in some areas, I am so strong and others, so weak. My IQ scores range from 60 to 131.

It's a journey towards self acceptance. Try to appreciate yourself as you are.


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