Mark, thanks soooooo much for your post. I just kept nodding (gently) my head.

I was lucky to have an excellent neuro-psychologist who clearly understood and recognized how brain injuries play out in the high functioning. He really went to bat with my GP who figured I was still "smart enough."

What outsiders need to understand is that deminished processing speed is only one part of the puzzle. People with serious brain injuries don't even have all the wires (axons) necessary to get proper imput and to process it. Mark talked about his difficulties visualizing. I just can't see patterns, which makes organization pretty much impossible. Like many of you, I am constantly bombarded with sounds (ticking clocks, multiple conversations, passing cars, ladybugs farting) that I can't filter or prioritize. Then there's the constant ringing in my ears. Oh yes, pain and fatigue are also great for cognition.

Ironically high functioning people are often under-diagnosed because what's left of our intelligence allows us to find coping methods. For example, before I'd had any cognitive therapy, I'd already learned to line up all the ingredients in order before cooking and to put them away as I used them.

All that said, I don't think lower IQ patients are getting a fair shake either. How elitist it is to say that that their TBI doesn't matter because they weren't smart anyway? I'm not great at patterns, but I see one here: the TBI patient can't win. Think about it, the TBI doesn't matter, either because you were too smart or too stupid before it happened. As always, the TBI patient gets shafted.