Tuesday, July 19, 2011


The therapist recommended that we arrange to have Neuro-psych testing done on our son. 

We had no idea that Neuro-psych testing even existed.  Neuro-psych testing is a special series of psychological tests, including an IQ test. 

We were going to be able to find out how his brain worked!  The therapist also thought that it could help us understand more about why he has trouble in school.  She thought that we would be able to find out what other problems he might have that would have an impact on his abilities and on how he learns.

This is the recommendation that she wrote for the pre-registering paperwork:

“He struggles with school including following directions and following through even when h seems motivated and is cooperative (not defiant or oppositional).  During some interactions, he seems to have the abilities that one would expect of someone his age.  At other times, he does not seem to have the reasoning skills that we would expect of a well-parented child of his age, and we have questions about intellectual functioning and executive functioning.  I suspect that he covers for himself when he doesn’t know things or understand what it is that’s expected.  He uses his sense of humor and avoidance as well as other strategies.  Also, he has significant visual impairment, and we’re wondering if he does not receive visual information due to perhaps filtering out since so much is blurry to him.  What recommendations can be made or referrals for occupational therapy or other interventions to help him find a successful career path?”

Wow.  That is a lot to think about.

She had come to really know a lot of things about our son during the previous 4 months or so.

I would say that a kid who got himself started on drugs at the age of 12, definitely has a problem with reasoning skills!  It was nice of her to say that he was a well-parented child, though.  She does seem to think that we are good parents and that our son should be glad that he has such good parents.  It makes me feel better about how things have been when I hear her say that.

We had to wait five weeks for the appointment.  Then, the testing lasted for seven hours.  After it was over, my son said that he didn’t know that a brain could hurt, but his did.  He said it was more like a pulled muscle than a headache. 

We were interviewed together and individually before the testing started.  During the interviews we learned that drug use to the brain is just like having a traumatic brain injury—much like the concussion that he had from crashing into a tree while snow-boarding without a helmet.  She said that the concussion was not a good thing for his brain, either.  Even a few weeks of drug use can lower a person’s intelligence.  Especially drugs like Ecstasy.  She was genuinely sad to learn that he had used Ecstasy. 

And, a baby born with drugs in his system starts out with possible damage to the executive functioning area of the brain.  If that child uses drugs at some point, he just does more damage to his executive functioning abilities.

I wanted to learn more about executive functioning and found out so much that explains why my son has struggled in many areas.  Problems with executive functioning can affect:
Decision Making
Deciding what to do with information or knowing what information is relevant
Error correction or trouble shooting
Needing to override automatic responses
Technically difficult situations
Dangerous situations
Situations that require the overcoming of a strong habitual response
Resisting temptation
Being able to select the appropriate responses or behaviors
The ability to recognize and learn patterns
Having the cognitive flexibility to respond to set changes and make a shift in set
Relatively simple processes like attention and processing speed.

Two weeks later we met with the Neuropsychologist for a verbal report on the findings from all of the tests.

I took notes as fast as I could and they came out like this:

       Verbal comprehension:  average range
       Vocabulary:  excellent
       Comprehension:  average
       Social conventions:  harder
       Perceptual reasoning:  average
       Working memory:  average
       Processing speed:  Below average 

       How quickly you can access your intelligence shows a significant difference. Your brain goes slower than your intelligence.
       People who have this, often give up because the big discrepancy between the intelligence and the processing speed causes frustration to the system.  It likes things to be even.

       Processing speed is affected by drugs and alcohol.  It will just get worse if he keeps using.  He can’t afford to do that anymore.

       School will actually help protect his brain.

       Reading:  average
       Math:  high average
       Verbal fluency:  Very superior
       Vocabulary:  average
       Fluency:  Very superior

       She said with his verbal fluency being so superior that he would make a really great salesman and that he should make sure he uses his powers for good, not evil.  She laughed.

       Now when they tested verbal fluency in a situation of switching back and forth from one subject to another, he went back down to average.  So, his ability to switch back and forth brings him down.

       His visual function is average to low average but is based on his poor vision.

       He should pick a verbal field of work over a visual field of work.

       Memory Function:
       Visual:  low average, more difficult
       Verbal:  Fantastic
       Word selective memory:  high average
       Object recall:  high average
       Paired recall:  no difficulties
       Verbal memory:  looks really good

       Executive functioning: 
       The switching ability that she mentioned earlier is a discrepancy that creates a problem.  Most of the world can shift from point to point with no problem. 

       He expects his brain to “click fast” and his “clicks slower”.
       When he gets frustrated she told him to take a break, relax, take a walk and then go back to the task and start again. 

       When things are structured and provide immediate feedback, he does really well.
       Unstructured, timed things that don’t give feedback he does not do well on.

       Recommends 504 plan to give more time for assignments and to break assignments up into pieces.

       His pre-morbid history affected the executive function of his brain, but he is still doing better than average.

       Said again that he should pick a more verbal job than a visual job.

       She said that nothing is stopping him.

       He should make sure that he doesn’t use drugs or alcohol because he has enough risk factors.  Everything will change for the worse if he continues.

       He should set a goal for healthy living and exercise.  She said he should become a health food fanatic.  She said that it has been shown that exercise improves brain function.

       Mood functioning problems:
       Shifting of tasks
       Working memory
       Keeping on task
       Staying on task
       Giving up before you start

       She asked him how he could approach tasks more slowly and deliberately.
       He said that he would have to make a conscious decision to slow down.
       His processing speed is so significantly different that it takes longer to access it and he stops trying.

       She said for on-going support:
       Mood functioning
       Possibility for cognitive therapy to learn to create structure when there isn’t structure, but right now school is the best thing.
       Substance abuse disrupts structure.

       Executive functioning has more difficulties in problem solving and switching.

       Keep ongoing evaluation of visual function.  Occupational therapy for visual function is in its infancy and will be a possibility in the future.

It took several months to get the actual written report.  This is the paragraph that she wrote about her impressions:

“The patient is a 14 year old male who was referred to a neuropsychological evaluation in order to assess his current cognitive functioning.  While intellectual functioning is noted to be in the average range for verbal and performance domains, his processing speed is in the borderline range.  This represents a significant discrepancy in his functional abilities and likely is exacerbating affective and behavioral functioning.  Further concerns in this evaluation indicate marked differences between high-average to superior verbal abilities in multiple situations as compared to low average visual spatial processing.  This is likely linked to lifelong Nystagmus and resulting is problems in scanning as well as incorporation of information.  The patient is demonstrating difficulties in executive function, again complicated by the above noted problems.  Finally, these problems are most likely associated with difficulties in mathematics (given its heavy visual processing component) as well as visual memory issues.  This patient also demonstrates mild disruptions in delayed verbal memory functioning despite intact immediate performance.  This is again likely linked to executive function disruptions and processing speed difficulties.  It is a further complication for academic achievement.”

Some of the most interesting things that we learned were that his intelligence is above average, but his processing speed is below average.  This means that he has difficulty accessing his intelligence as quickly as his brain wants him to.  When learning anything in school, or when trying to complete a problem because of this discrepancy, his brain just tells him to give up.  The reason that the ADHD medicine helps is that it helps him speed up his processing a little bit AND helps him with his motivation.

The second thing is that every use of drugs and alcohol will adversely affect the processing speed and make things worse.  She repeatedly told him that he can’t afford to do that anymore because he has enough risk factors as it is.

In school from now on, he will need to be given more time for assignments and break assignments into pieces.  Getting one piece of an assignment done and then receiving immediate feedback on it will help him.  He will need to approach tasks more slowly and deliberately, making a conscious decision to slow down.


I have been saying this for years!  I have repeatedly told the teachers that he has a hard time getting the information from his brain to a piece of paper, that it took 2 or 3 times as long as normal to complete assignments, and that he has a problem sticking to an assignment until it is done!

It feels so good to have PROOF.  Now, the school will HAVE to accommodate him and help him succeed instead of just setting him up to fail!  I think it is going to be a very time-consuming process to set up and manage, though.  But, I am excited to see how this information can help him have 3 more years of school that are actually successful for him.

This is what I mean about getting more and more information that I wish I had known and had validated years ago.  He could have had more help in school.  He could have had more understanding.  He could have had more success.  We could have had less school-related arguments.

He could have not turned to drugs.

Could have..

They say you should not “should” on yourself.

I guess we can’t “could” on ourselves either.

But, I probably will.

No comments:

Post a Comment