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...