Neuro psychiatric Evaluation Questions

[humbleyourheart]

We finally received the results of our neuro psychiatric evaluation and I have a follow up with the doctor tomorrow to go over them. Basically her recommendation is bipolar with an attentional component. I may be in denial, but I feel like there is more to the test results. I wondering how much of her recommendation is based on our input rather than the test results. I have limited knowledge as to what any of it means and I don't want to insult her with all of my questions so I'm wondering if someone can help me out.

The WISC-IV test indicated a low-average on all measures of motor processing speed (PSI = 85, 16th percentile). To me that seems really low and could explain a lot, but a learning disorder isn't indicated.

The WJ-III test showed suppression of his scores on tasks that were timed, particularly math fluency.

The CMS indicated mild executive dysfunction and working memory difficulties, but no memory deficit.

Her findings for these tests say he may have slowness due to fatigue caused by medicine and his perfectionistic tendencies. While his teacher has noted his being tired at school since starting the medicine he is definitely NOT TIRED at home. He is full on energy as soon as he hits the door. He has had a problem since 1st grade with being very slow from his work and has always required extra time to get his work done, but we did not start medications until just this year (3rd grade).

She also tested for Autism Spectrum Disorders (ASD). Taken together the scores did not indicate presence of Autism Spectrum Disorders (ASD) she says. But one of the scores falling into that range are being explained due to him having flat affect. This was the reciprocal social interaction portion. His score was 5 which is noted between the autism and autism spectrum scores. I honestly don't think this child has flat affect. He can and does get very excited about things.

One other thing noted was his lack of insight into his emotions.
She doesn't feel he is need of an IEP (fine by me), but could use "accomodations" of extra time (the teacher has already been great about this).

So can anyone offer any thoughts??

Thanks much.

 

[Fran]

What sort of thoughts?
I would write down questions so that you can have them answered by the Dr.
Our kids are seldom just what is discovered in testing. There are many levels to their various disabilities plus different combinations. in my humble opinion, testing tends to be 2 dimensional vs. a person who is so much more than that. It's important that we acknowledge the child's whole person and not just test scores when working with teachers as well as other professionals. The plan is to educate your child armed with the facts of the testing and his needs for academic and social learning.

 

[humbleyourheart]

I have all my questions noted. I guess I am questioning the diagnosis of bipolar. And I am wondering about the low processing scores. Has anyone had scores that low (16th percentile)? What does this mean?

 

[TerryJ2]

So, he was on medications when he was tested? I would not recommend that.

I agree with-your hunch, that with-poor motor control and slow math processing, he could have an Learning Disability (LD) or even Asperger's.
However, he could have BOTH bipolar and Asperger's.
I would type more, but my mouse is going crazy and flying all over the screen.

 

[TerryJ2]

P.S. How long was the testing?
Also, Aspies can be very loud and aggressive, so it depends upon what you mean by "flat effect." I've seen that written a lot and it means general lack of facial expression and inflection, among other things. When kids are very young, like yours is, it is SO hard to tell the difference.
Best of luck tomorrow. I hope others here have more insight.

 

[smallworld]

Most neuropsychologists won't outright diagnosis bipolar disorder, but will leave that to a child psychiatrist. I think you need to ask her what makes her think this is bipolar and not something else.

Slow processing speed and low math fluency can be attributed to anxiety. That's exactly how my daughter M presents, and her diagnosis is most assuredly anxiety.

Abilify can definitely flatten affect. That could be what contributed to the tester's observations.

Good luck tomorrow. Let us know how it goes.

 

[DammitJanet]

I dont know whether or not my neuropsychologist would have delved into a bipolar diagnosis or not because she told me she was going to leave that be since I already had that in place for years. She seemed to want to argue with me and my therapist on my borderline diagnosis but I could care less what she thinks on that...it is staying. She is one opinion...I have two other professional opinions plus my own that say I have it. LOL.

 

[JJJ]

What were the complete WISC-IV subscores and composites? One score in isolation does not tell much.

 

[BusynMember]

The neuropsychologist we took our son to saw him for ten hours. He had worked in Mayo Clinic for ten years and had just moved to Wisconsin. He was pretty darn good.

He told me that ANYONE, even Mayo, can be wrong and that mistakes are made all the time. There are no blood tests. If you question the bipolar, like I did, get a second neuropsychologist opinion. It is common for an Aspie to be misdiagnosed as bipolar, and you don't want to go through what we did if your child is misdiagnosed. My son still has residual side effects from the heavy duty medications he took for the bipolar that he doesn't have--including obesity and thyroid problems. He has been off all medications for four years. He was thin and fit and ate normally before the medications. It could have been worse. There could have been long term movement disorders from the anti-psychotics. He reacted poorly to them.

I am NOT anti-medication. *I* take medications. I do have a mood disorder--I'd be a suicide statistic if I hadn't found my medications. However, I am a big believer in second and third opinions with a child. Even for an adult like me, it can take years to get the correct diagnosis. If your neuropsychologist was a good one, she would have tested from 6-10 hours on every level, for everything. Even so, you are doubting her answer, so I'd definitely take him to somebody else and see what he/she says. And I wouldn't tell the next one what this one said. Unfortunately, many are lazy and just mimic what they think we want to hear--and refer us for medication. Did your child take any version of the MMPI? As far as I know that is the closest tool any psychiatrist or psychologist has to diagnosing bipolar. I have taken that test three times.

Take care!