Help with Neuro-Psych test
 

Folks with knowledge on the issue:

I have mainly severe vision issues (convergence, tracking) as well as auditory, but the latter is related to the former. Anyway, I went and did the Neuro-Psych test, standard test. I did it for 2 reasons: The Dr asked for it and eventually work would do for disability. I tried my very best on the test, because the last thing I wanted was to be accused of malingering. I was upfront with my work: cognition is almost fine, it is just that vision work, especially close vision, that sets off symptoms like hell. So since there is no objective way to detect symptoms based on vision, trust is very important. They have to trust that I am truthful. The last thing I want is some indication of malingering, god knows how much I want to go back to work!!

So I did the test over 3 days. Because it is mostly writing stuff on paper, which obviously sets off symptoms pretty badly. So I was doing the test under harsh circumstances. But I gave it my best.

The problem: My test results were so bad, that the report suggested the possibility of me exaggerating symptoms (sx). This drove me furious. The Dr added a note saying that based on my sx these results are likely, and are not due to exaggeration on my end.

But this is still problematic. Work will think I am malingering. I am very nervous about this. I am thinking of going to another doctor and doing the test again and pay out of pocket this time. Next time I can push through without consideration of the few weeks of pain that will follow the test if I indeed do converge. Because when I did the first test, I was careful to always take a short break and look away from the paper to minimize major setback (which I had many times in the past when I pushed myself).

Any thoughts would be much appreciated. Any of you got such reports?

Please help

If the vision was a problem causing you to push, this can impact thinking such that your answers may be inconsistent. One can end up over-thinking and messing up.

I've had three NPAs. It is best to not push, even if the tester is trying to get you to work faster. Letting the answers flow naturally will give a more consistent score.

If the tester tries to push you and you are already being diligent, tell them to back off and that you are working as fast as your brain allows. It the pushing is because you are getting distracted in thought, accept the prompts.

Even with high validity scales, the interpretation by a biased tester can be twisted to put doubt on the validity. I scored near perfect on the validity scales (48 and 49 out of 50, 37 or lower indicates malingering) but the psych said I was faking because I had some very high and very low scales.

Would it help to cover one eye so convergence is not an issue? Have you practiced reading with one eye?

Thanks for your reply. I do the eye patch thing, but for some reason it does only help marginally. More on that in another post.

Basically I did not push myself too much since I know this comes at a cost, and I started having pretty bad symptoms during.

My question is really: Will such report that suggest "possible exaggeration" on my end be problematic when it comes to disability insurance? Should I give it another try?

If you have done 3 I am assuming you paid out of pocket for 2. Did you repeat it to get a better score and avoid false claims on their end?

That’s absurd they would claim that and also the NP test is a complete joke.

Definitely stand up for yourself and don’t do anything that will make your symptoms deliberately worse.

At end of day, disability system is corrupt and anyone with mild TBI is screwed. I have the convergence issues same as you. Without my prism glasses, I wouldn’t be able to work. Even with them, it’s a near impossible feat but would stand 0% without them.

Insurance (Work Comp) paid for the 1st. He was biased against me.
Health plan paid for 2nd and 3rd years later. I only paid a co-pay for each of 3 sessions for the last.

2nd was to get Social Security Disability since 1st was too old.

3rd was to validate PTSD and cognitive issues from another trauma.

1st was PhD who was biased in favor of Work Comp since they paid him extra for photocopying 60 pages of medical records and my comments. (In violation of Work Comp statutes). He was able to get twice the normal WC fees. He stated that despite my near perfect no malingering scores, I was faking most of the test. He said nobody could have a high IQ and low memory and processing scores.

2nd was a fresh ink Psych D finishing his fellowship/residency at Kaiser Health Plan. He was clueless and relied on 1st's comments. He could not even do a proper PASAT.

3rd was a doc who spent years in a neuro rehab hospital and was excellent. He fully understood the effects of brain injuries since he had spent 20 years working with only brain injury patients.

All 3, spaced over 14 years, had almost identical results. I'm not getting better but I am not getting worse.

One of the things I have learned is quite simple. I don't pay attention to symptoms directly. If I feel the need to slow down, I just slow down. But, I have been living with PCS for 50 years.

The 1st doc was confused when I said I needed to pause when a leaf blower was outside the window. He was clueless. He also though it was odd when I complained about looking at him with 30 framed certificates on the wall behind him. He had no understanding of over-stimulation.

I had an additional problem. With 1 and 2, it was obvious I had a higher intelligence than the PhD and PsychD. They were intimidated. No 3 was impressed with my IQ and saw how my memory dysfunctions and processing slowness was in conflict with my IQ and how that can be very frustrating. He actually stated he had never seen such high WAIS IQ scores with his patients. But, he was also smarter. We even joked together when I told him I had answered a few questions wrong on the IQ test and had arrived at the correct answer.

I encourage anybody getting an NPA to try to find a neuro psych who is heavily involved and even has his office in a neuro rehab hospital.

Other than a disability application, the most valuable part of the NPA was validating what I perceived as dysfunctions so I knew to not fight against my limits and get frustrated by them. I just find a way to work-around and go on.

Thanks very much.
So my question is whether them suggesting malingering (1st and 2nd) was an obstacle for you getting insurance/social security?

Thanks

The 1st was disregarded by the Work Comp judge. I was without an attorney. He sort of agreed that I could not have such a high intelligence and such low memory and processing functions.

SSDI used the 1st and 2nd and approved me for disability. But, I had an attorney. I was denied without an attorney.

Thanks very much.
I have a PhD and work at a place that is very selective. And my work involves maths and stats.

With the test my IQ turned out so low. I am assuming they compare me with peers of my education level. In Maths I was only better than 10% of respondents, and so on. So the test writeup says low IQ and possibility of exaggeration!

My fear is that this "possibility of exaggeration" is scaring me. I have to establish trust with them, and trust might be broken for me to be admissible to Disability pension. I am also insulted by the results of the tests, I have a feeling that the examiners were harsh (they are at a doctor's office that sells the treatments LLT, and neuro feedback).

I feel I can do better by pushing myself, perhaps take an anti-nausea pill before the exam, and bite the bullet (take the risk of increased symptoms for the following months). It just so happened also that I had a break-up the day before the exam (its second day, it was divided in 3 days), and my sx were to start with not so good that day. So overall I think I can do better.

So if I can afford another test, I would perhaps do another one. But I wonder, if I do not, and go with the one I have, whether they will believe me, that I am not malingering, that there is so much I can do with my eyes. As I type this post, I use one eye, I take breaks, look away, then relax my eyes, then get back to it. This is how I have been doing things over the last 2 years. There are days (such as the exam day) where things are worse, I cannot even look at the screen (so I wouldn't be even able to write this post).

I am stuck between a rock and a hard thing


PS: Mark, you are right about closing one eye, but this has puzzled me and the doctors that it does not help much. I am going to write another post about my situation later.

The issue you have is the same as me. You cannot maintain the pace and persistence needed to complete a full day of work. Yes, you can do short stints of the tasks you need to do. BUT, you cannot complete the equivalent of 2 - 4 hour periods of work like a normal work day. Plus, you cannot be certain what days your mind is up to the task of getting even a few hours done.

I can get a lot done if I have complete control over the pace. I cannot function with time pressures. I can work for a hour then take a break and return when my brain is back to work. If I need to do serious thinking work, I can get a few hours done over the space of a day. I bet you are the same.

Do not try to work about the stresses of the test. It will only make the result unreliable. Roller coaster results will confuse the test scorer.

What clinic/office did the testing? If I remember, you are in Texas. There is a great concussion doc in Dallas. I think his name is Walker. He does neurofeedback, too.

Actually I am in DC. I went to a clinic to try neuro-feedback. But the doc there recommended an ECG and a NP test. Even though I did ECG already he said his is more sophisticated and shows maps of the brain and some markers. He started pushing not only for Neuro-feedback but much more so for LLLT. He kept saying this will make you feel better, help you heal.

So I don't trust the guy. Would you? But since I knew I needed to make these tests anyway, I went ahead and did them at his clinic. I can tell you later about his ECG findings (and whether you think they should be taken seriously), but I am afraid that because he wants me to buy his treatments so bad, they might unfavorably scored me on the test, or treated me during the NP test. But as I said, he added a note on the report saying that the findings cannot be attributed to exaggeration by the patient...

I think it is time for me to reach out to an attorney, but it is very hard to find. I only see these big law firms and was recommended to stay away from them...

Having a bad attorney is better than no attorney!

subtlebraininjury.com has information about finding a good attorney.

A big firm may have a subtle brain injury specialist with a support system for that attorney. Don't count them out without inquiring first.

You do not need a local attorney, just an attorney who practices within the state and specific courts. (federal disability courts)

Thanks very much for the link. I will contact them.
Quick question: the NP scores are based on people with my education level?
For example I did only 10% better in maths compared to the control group. I have high level education (PhD) in a field that requires Maths.
Should I take it that they are comparing me with PhDs?
Otherwise it is really a shocker.
Thanks

Neuropsychological Evaluation
 

To Mark from Idaho: Forgive me if I get this wrong (my brain injury = cognition), but it sounds like the 3rd guy knew more. If they all got the same results, and he writes your report, it will show you are not malingering, right? I would document the differences in their training so his opinion is weighted more heavily. Perhaps he can offer explanation as to why the others said what they said. Some of that may be cookbook manual stuff used in computerized scoring or inexperienced clinicians. If you find out that's it, you can reduce their credibility. Also, workman's comp paying extra for copies covers the cost of the copies and personnel's time while making them. If the payment doubled, there no way workman's comp will pay for that (I was a psychologist who did these evals). You can point out the possible bias due to payment, but the other side will probably point out a similar bias if you cash pay the third. So be careful. I hope this makes sense. I have long recovery to go! I wish you the best.

DrSky,

Welcome to NeuroTalk.

The extra pay for extra pages was at $60 a page, an extra $2000 over the statutory allowance for an NPA report. He actually asked me to write as complete a report as possible. He photocopied it and got paid. He photocopied other medical reports that WC already had just to pad the page count. They all did. It was like a snowball. Each successive report included all of the previous reports with pay per page. When I requested copies, they mistakenly gave me a copy of his cover letter comments about being allowed to bill extra for the copied pages.

The previous industrial doctor had a records collection agency compile a stack. He spent 10 minutes with me and billed $1200 for the stuffed report. The employer was self-insured and spent $5000 for reports to get the admin judge to rule against me.

The first psychologist to assess me for SSDI saw how corrupt the WC process had been.

The 1st and 2nd could not believe a WAIS-II of 88 to 99% could have 10% processing speed and 5 and 12% in Wechsler memory without faking. But, the validity scales were 48 and 49 out of 50. I was able to get the raw data and notes ordered by a unrelated but sympathetic neuro-psychiatrist. The Trailmaking Test results were not even interpreted correctly. The difference between the A and B test was substantial but reported as within low normal.

I have seen a distinct difference between NPs who work with neuro rehab in a rehab hospital and those in general office practice.

The bit that I do not understand about this: if you got such a high score on the IQ WAIS test doesn't that already mean you were giving it your best? These were part of the same test no? The IQ tests and the memory tests, even if on different days. Maybe I am wrong.

On a separate note, and I am really sorry to bombard you with questions, it sounds like I cannot do another NPA without informing and sharing the previous results with the new practice?

PS: I contacted the lawyers from the website you mentioned, they say they only take big lawsuits and do not provide paid consultation.

The concern on the tests is that people try to fake answers to look worse than they are. The WAIS is separate from the Wechsler Memory and other tests.
The PhD was just a jerk. He stated that despite the scores indicating no malingering, he did not believe the test scores were accurate. He did not believe I could test so high on the WAIS and low on the Wechsler Memory without faking.

He was not up to date on reading journals. This issue had been discussed in a journal article. The disparate scores are believed to be a direct indication of organic injury. Memory function is impacted greater than intelligence and high intelligence cannot be developed with low memory function.

The scores indicate that high intelligence was developed at the same time as high memory skills. The organic injury impacted the memory because memory is a dynamic real time skill but the intelligence skills are basically an over-learned and historic skill so most of the intelligence remains, just at a slower processing speed.

He tried to blame my low functions on depression based on a few scales on the MMPI-II but the Cripe (Cripe Neurological Symptoms ) analysis suggests those few scales are indicative of organic injury. Few NPs use Cripe because he never widely published his work.

But, there are plenty of neuro psychs who believe they are the ultimate authority and do not think outside the box.

"This scale looks odd. I wonder what it can mean." is not in their though process.

So do you think I can take another one (and pay out of pocket) at another clinic while completely ignoring the one I had? I think they did a bad job (perhaps intentionally) to make me look worse and offer treatment. So if they (work or another clinic) find out, I could just tell them that there were circumstances that meant this test was inaccurate: (a) I believe that there was a bias on their end (2) The test happened during a setback, and (3) I was actually dumped by my gf the day before, true story... I made a mistake of not telling the clinic about it...
I just don't want anyone to think I am malingering, because I am not...

I wouldn't pay a dime for out of pocket test. I stand by my assertion that Nueropysch test is garbage for most TBI's and lean will always be to classify any symptoms as depression/anxiety.

The questions they ask for IQ are a complete joke...simple math problems. Who is the president of the united states. It doesn't measure the head pressure, headaches, vision problems, and brain fog that goes along with taking this test and how exhausted one is afterward.

I get why you want to be persistent because you know the truth but I'd fear you would just waste more $ down the drain when you could be putting that $ for some new therapy you have yet to try.

Bacchisimo,

Could you scan and email the report to me through NT. Left click on my screen name and choose Email Mark in Idaho

I'd like to read what they said that has you concerned.

Thanks so much Mark. I will send you a scan of the findings once I am back home from travels. I very much appreciate your help!!

Hi Mark,
I sent you an email but I do not see the option to attach a document (PDF), can you please let me know how that works?
Thank you

send me any email to reply to. I'll reply. Then you can reply back to my email address with attachments. That keeps my email address off the public forum.
You have your profile set to not receive emails.

Sorry, for that. Now I changed preferences, allowing members to email me. I hope I got it right. It took me a long time to figure it out. sorry for the inconvenience.
Thanks

B,

I read the scans of the reports. I don't think you should be concerned about the off hand malingering comments. The italics comment is more important and in your favor. I can see that you are struggling severely.

I don't think you should try to get another NPA but you should find an attorney or disability representative who can help you understand the NPA report. I think your struggles make it hard for you to fully grasp all of the issues in your favor. Your anxiety that leans toward a confused sort of paranoia is working against you in your mind. This is not uncommon. There is a lot to sort through for even a mind that is not struggling.

If you have access to any historical assessments of your abilities prior to your injuries, they could be used as a comparison to today. College boards, SAT, ACT, GRE, GMAT, Assessments by coworkers, professors, advisors, teachers, and such can put context to your current state.

Hi Mark,
Can't thank you enough for taking a close look into my case. Your words are reassuring. Per your suggestion, I scheduled a couple of consultations with attorneys.

I will try to not stress about it. You can see my scores are very low right?

To answer your questions: Yes I must have somewhere GRE scores, also I have a PhD. I did a short version of the NPA following my first concussion - when my visual symptoms were not as severe - and I did much better. It was however only an hour test (3 years ago).

Thanks!
B

I know how you feel. I passed some Neuro-Psych test too, but it's hard because some other doctors argued with me that the test is too much "subjective" while others thinks it's valid?! If it wasn't valid, why would this test even exist then? My own result came really low myself and it shows how I lost a lost of my memory/concentration skills for the past decade, but still they still argue and I struggle to get disability myself...(I'm from Canada BTW). I'm with a lawyer myself and we're trying to find a specialist.

Hope everything will go well for you, as it'll give ma bit of hope!