formal diagnosis?

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my understanding from having to deal with psychiatrists and counselors and psychologists with two of my kids who are bipolar, is that psychologists are much better than psychiatrists for actual real diagnosing of mental disorders.
psychologists administer tests whereas psychiatrists use subjective testimony of therapists and parents to reach their conclusions.

mri's being used to diagnose something like this would be prohibitively expensive for most people, i think.

Are MRIs or psychiatric diagnoses more prevalent? If the psych ones are, that might explain why so many people are underdiagnosed.

Tim

If a Neurologist ordered it, your insurance would pay for it.


I wouldn't give a Psychologist the time of day. It's still subjective observation, most likely from a NT. There's no way I would trust them to tell me what is physically happening inside my brain. Of course, I wouldn't go to them from the onset. I call it a brain disorder and not a mental disorder. That way it doesn't get confused with people thinking it's emotional or some crap. The brain isn't working right. That's a concrete thing and people can handle it. You wouldn't go to a Psychiatrist or a Psychologist if you were in a car accident and had brain damage. You would see a Neurologist. Now, you might see a shrink to deal with the trauma that caused to your life, but that would be different. See what I mean?

Bipolar is a chemical imbalance, isn't it? Can they see that on a fMRI or a regular MRI? I would think so, but I really don't know. I also think Bipolar presents as a specific set of symptoms where AS is a spectrum of symptoms (and they are realizing more all the time). AS definitely shows on a fMRI, that's why I say that. Now, if you are talking comorbid conditions like anxiety or depression, then I would say see a Phsychologist or Psychiatrist. They can diagnose and treat that.


Hopefully that explained the difference. It's just me. I would have to have concrete evidence and not subjective observation.

How do I get to see a neurologist and get an MRI and would it really show any difference on the MRI? I am assuming that is a form of brain scan or something???

Check out your insurance. Some insurance requires your regular doctor refer you to a Neurologist (which is really easy to get them to do). Other insurance lets you go directly to a Neurologist. If you have PPO insurance or HMO, make sure the Neurologist is on their list of approved doctors. They either won't pay or pay as much if the Neurolgist isn't in those cases. Some insurance companies, even PPOs, do not make specialists be on the list. All of the rules are different. You should have an insurance policy guide that explains that.

I can't remember if you are in the UK, but if you are and you don't want to ask your parents the rules there with the health care system, I will find out for you. I know someone over there who would find that out. So, just let me know. I believe in the UK, the regular doctor has to recommend you to a Neurologist, but I'm not positive.


An fMRI shows functional brain imaging using colors. It's based on heat sensing in addition to magnetic resonance imaging (MRI). The heat sensing shows where your brain is functional. In Autistics and people with Asperger's it actually looks different and you can see where the messages aren't making it and the executive functions that interpret things in social situations aren't working. A Neurologist could show your parents a fMRI or your brain and a normal brain. The difference would be immediately apparent. It's very hard to argue with evidence like that. It would be like the Neurologist showing them a MRI of brain damage and a fMRI of what that means functionally to the patient and your parents saying, I don't believe that, she's just lazy. See what I mean? That would not go over well with a Neurologist and they would have plenty to say to your parents about it. They aren't exactly known for bedside manner.


I hope I explained that well enough for you. I'm trying to make it as easy as I can to understand. I tend to use computer terminology to explain it many times and that loses some people. So, if I do that to you, just call me on it and I'll explain it better.

I'd like to see the source of your information. There is currently no brain scan that can reliably be used to diagnose any form of autism. There are a lot of studies that have used brain scans and they've seen differences in brains of people with forms of autism, but lots of people show differences in different areas.

I think it depends on the neurologist too. I suspect most of them are clueless about things like Aspergers though in truth they should be the ones diagnosing it and not psychologists. The neurologist I saw believed just because I have Aspergers and complained of seizures which she couldn't find that she should put me on psych meds. She told me all syncopy should be treated with Lamictal (most commonly prescribed for Bi-polar) or Topomax(known in the medical community as Dope-a-max). Seems like a lot of psychiatrists prefer to use meds to shut up their parents and make them go away. If you're doppy & groggy all the time you won't cause problems apparently is their thought.

Here's some.


http://www.wrongplanet.net/article274.html

This one is a strict MRI and PPI study by Harvard: http://brain.oxfordjournals.org/cgi/con ... 125/7/1594


Here's an MIT study getting ready to start. It explains how the MRI and fMRI work. http://web.mit.edu/gabrieli-lab/participate.htm

This one from Stanford flat out says that observation of behaviors to diagnose in the past is insufficient and it is now recognized that it is probably pathophysiology and etiology based (and that is from the Psychiatrists and Psychologists themselves). This talks about what is seen in the different types of Neuroimaging. http://journals.cambridge.org/download. ... 4ecca8b84c


Many I didn't include because they require you to purchase access to the Neurology journals. I think if I copy those, I'll be in violation of copyright and since I write for a living, I'm a little leery of going there. I can put the links in if you want to purchase access though.


I have to go write. Let me know if that's enough. I can keep searching through for you. It will just take me awhile.

For me the benefit was mostly just for my own sake to explain why my childhood was the way it was and why I seem different from others. But I wasn't actually looking for a diagnosis when I got it. I didn't go to a psych; I was diagnosed by a M.D.

I don't like the thought of using AS as a crutch. I managed to find employment without knowing I was autistic so no need to start using the diagnosis.

Now the diagnosis probably will help me in getting treatment for CAPD because it is liked to autism. But I am seeking the treatment quietly and not making a big fuss aka without telling all my drs, any of my family or my employer about it.

I am considering going back to college for another degree and I might consider using AS in order to get permission to take tests in a private room because I am distracted very easily. A friend with depression is actually allowed to do this and they even let her test with open textbook. I however would not want to use an open textbook because it seems like cheating to me. But if I can us my AS diagnosis to get to test in a quiet room I will go that far. Otherwise I don't even speak of my diagnosis to others. I did mention it to one neighbor and she suddenly started treating me like a mentally ret*d. Mainly only other autistics in town know I am autistic. Not telling a soul at work.

Ticker a Neurologist told you that or Psychiatrist? You lost me with that last statement about seems like a lot of psychiatrists... I agree about that. And you are right, you also have to be careful of the doctor. One thing you can do is contact a Neurologist like James Brasic who has been studying Autism and Asperger's for years (among other disorders). He helped one mom on here quite a bit even though she was in the Southwest and he is in the Northeast. She emailed him and he emailed her right back and did so several times.

ZanneMarie sorry I lost you. I find myself too wordy so I try to condense my writing and it ends up incoherant I suspect. The neurologist told me I should be on psych meds for AS and the syncopy. From listening to stories of friends I believe psychiatrists rely mostly on meds to deal with patients whether it is AS or something else. For instance any disruptive kid these days can get labeled with ADHD and forced on meds when the real problem may be a bad home life. Or a patient is labeled as clinically depressed thus gets put on psych meds when the real problem is they are being abused by someone and would do better if the dr would help them get out of the abusive situation. It's like "oh you have a problem- here, take this pill!"

I think neurologists should be the ones diagnosing Autism and not psychiatrists or psychologists. However having been to three different neurologists (for various health problems) I don't think they know anymore about autism than the common man on the street. I mean I have had strange abnormal brain MRI's and none of them could reason as to what the problem could be so no way would I expect them to be knowledgable about Aspergers.

On another note I find it incredibly wrong that two of the neurologists I saw wanted to put me on Topomax. Not for any neurological problem, but because they said it would make me lose weight. Since when should neuros be treating weight problems? I don't doubt I need to lose some weight, but I seriously doubt extra pounds has anything to do with brain lesions, neuropathy, migraines, unexplained syncopy or autism which I went to them for. I think there could be a glut of unqualified neuros who only know one thing to do and that's hand out expensive psych med samples and write you a life long prescriptions for them.

Could you PM with the contact info for James Brasic if you have it? Thanks!!

I suspect a PET scan might be of use in diagnosing autism if anyone would research that. I suspect it might also explain my own problem with syncopy which I think is considered a form of seizure, but not true epilepsy, but instead a brain metabolism problem. PET scans are fascinating and I think have great potential for diagnosing a number of things. However they are at least twice the cost of an MRI from what I have heard and not every insurance will approve one. Still trying to get drs to listen to me about what I think is wrong and getting a PET is a real obstacle.

I agree with you about the Pyschs and their propensity for meds. I've seen that so many times with friends (oddly mostly NTs, guess that's why I think they're so dramatic!). I think what you are seeing in Neurologists may be caused by the fact that they are only now getting them involved. I'm with you, it should have happened a long time ago. In fact, the Neurologists feel this way. But thankfully, what I'm reading is that the Psych and Ed. communities are also recognizing that subjective testing and observation is not enough. It requires Neurology and that is very encouraging.


Yes! I will send you Brasic's info. He seems like a really cool man in addition to being a Neurologist who studies this.

They have done some studies with Pets although they haven't used them as much. I think what they are doing, which is good, is using the FMRI in combination with the old Psych tests to see how the brain responds. They are using it to validate diagnosis and also see what's actually going on. Something they never did before. It's a really good change and I am glad to see it.

The first two just state what I basically said. They've found differences but there isn't enough consistency to use for diagnosis.

The Stanford link doesn't work, but I went to http://journals.cambridge.org and searched "asperger's" and "neuroimaging" and came up with what I think you were linking to, but it requires me to buy it. The blurb that it did have said basically that behavioral diagnoses suck and that brain scans would be better.

At this point though, we just don't have the data to do diagnosis via brain scans. There is no standard against which to compare. There is no scan that anyone can say conclusively "This is what an Asperger's brain looks like and if it doesn't look like this you don't have AS."

I know there is a neuropsychologist who does brain scans for diagnosing all his patients, but he does it for all disorders. He doesn't diagnose based on those brain scans, he diagnoses behaviorally and does the brain scans to make it seem like he's more legitimate and to get more money from insurance companies.

I think it is of significant note that all the studies have found differences in the same areas of the brain, including studies of monozygotic twins. Many of them are already going into clinicals. The reason the Neurophyschologists are using it is because they have openly admitted that their diagnostic techniques are lacking. They know they are going to have to get to concrete facts.

One thing is for certain, if they are seeing the same thing in all Autistic/Asperger's test candidates and they are, if you don't show it, it would be very unlikely that you are. The twin pairs showed clearly that the non-Autistic twins brains were different than the twins with it. That's what they were using to distinguish between them to study phenotype.


For Neurology to have only recently begun to study this, their findings are amazing. They've already dismantled some previously held beliefs. You can thank Pyschiatry for not bothering to ask them for assistance until recently. That's what happens when a brain disorder gets sent off to a "mental disorder" standing.