How to deal with incompetent neuropsych?
 

Given how inadequate current imaging technologies are for detecting "mild" brain injury, the neuropsychological evaluation is suggested by many as a good alternative to get "proof" of cognitive disabilities. However, most doctors treat the results as meaningless without the neuropsych's diagnostic impression. Does any one have advice/experience dealing with a neuropsychologist who ignores areas of difficulty/tries to fit everything into a purely "psychological" framework? Is there any way to get around this by having a second neuropsych re-evaluate one's results?

For instance, my tests showed up major discrepancies between premorbid functioning/academic performance levels and neuropsych results. They also showed extreme deficiencies in visual perceptual reasoning, executive function, working memory and visual memory. Neuropsych suggested these were premorbid weaknesses?!

Every neuro psych will have biases. His comments on premorbid conditions are weak. There are only a few tests that can estimate premorbid functions, and only in limited areas. They have to rely on other data like interviews with the subjects and family, etc. to arrive at opinions.

Why does pre-morbid vs post-morbid matter ?

"For instance, my tests showed up major discrepancies between premorbid functioning/academic performance levels and neuropsych results."
What were the discrepancies ?

What were your scales in visual perceptual reasoning, executive function, working memory and visual memory?

Thanks for the input
 

The neuropsych DID interview a friend and a colleague who attested to the decline in abilities. He also had copies of previous academic scores and old records like SAT. However, he works at an acute rehab facility and the message at the end was that any deficits were not significant compared to his patients. Clearly this is comparing apples and oranges as a neuropsych eval in my case is necessary for medical records for insurance to get benefits and to get accommodations in work ETC.

I failed the test of delayed figure recall, was 24th percentile in NAB shape memory delayed recall, 17th percentile in shape learning percent retention. My verbal comprehension composite was 99th but perceptual reasoning was 45th and working memory around that too. The test results starred that discrepancy was significant. Actually, it appears the executive function wasn't actually listed, only the WAIS logic and block design, which were 37th. Other things were average, some high average, but the tester told me that he expected from testimony and previous test scores that I would be in the superior range. After the test though he told me something was going on but he didn't know what it was, so he would ascribe to psychological. My speech therapist is very frustrated too because she thinks my reading problems are brain injury related. Sorry for the rant.

Did you do the Trail Making A & B ? What were your times for A & B ?

What were your verbal and math SAT scores ?
Did the WAIS include the different intelligence scales ?
How about WAIS processing speed ?

To a Neuro Psych who works with patients who were low GCS (Glascow Coma Score) and even comatose, the struggles of PCS patients are mild. This can be a bias. Some NP's think people with divergent scales are faking or have psychological causes to their problems. But, The validity scales will help with this. Validity scales below 37 show inconsistencies or malingering. Mine were 48 and 49 out of 50 but the NP claimed I was faking because my WAIS intelligence scores were high.

What benefits are you hoping to get from insurance ?

Accommodations at work should not depend on an NPA only. ADA applies to anything that changes how you can function on the job when compared to a normal person.