ALS affects both upper and lower motor neurons. The three people that I have know that have had it all started with difficulty with their hands and speech and/or swallowing. Weakness and spasticity were also symptoms they had. For one, it was the slurring speech that finally made him go to the doctor. I think that your neuro would have identified some abnormalities during the neuro exam that would suggest ALS. There is an ALS forum on NT that you can check out and ask questions about the initial symptoms they had.

http://neurotalk.psychcentral.com/forum6.html