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Book Excerpt: The Autism Assessment, Part 2

Yes, more from the formal autism assessment report prepared in 2006. This is from a chapter in my next book, due in early fall. Please feel free to ask questions or offer suggestions. This book is still being written. Your input can help make it a better book!

If you would like to support this blog and my other projects, you can download my current eBook for Kindle or Nook.
A Spectrum of Relationships is only $2.99 on both Amazon and BN.com and I would appreciate questions, suggestions, and reviews while I consider preparing a revised "second edition" next year.

Now, on with the current book excerpts.


Quantifying Personality Traits
Recall that I mentioned the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Intelligence Scale for Children (WISC) are similar evaluation instruments. It isn’t surprising that the evaluation I received at the age of 37 would be similar to the one performed at the age of eight. The instruments have been revised several times, and I do not recall if the 1976 evaluation used the revised WISC published in 1974 or an older version. 
The materials on the shelf at the psychologists’ offices indicated I was administered the WAIS-III. The results, regardless of any biases in the WAIS-III, do reveal my weaknesses.
Statistical results from the 2006 and previous assessments removed. There are several tables of data I do not wish to post online. Some of the data will be in the eBook. 
My “processing speed” and “coding performance” are miserable. I recognize that a second percentile score is not top-notch, but at least it makes the processing speed look outstanding. What is coding? Should I even care? Has my lack of coding skill affected my life? If it has hindered me in some manner, I haven’t noticed. However, I do notice my mind is slow at times. I’d rather be slow and accurate than fast and sloppy.
He excelled with crystallized knowledge base (long-term memory). A high average score was revealed for numerical mental analysis with an above mean result in terms of verbal fluency.
I am certain my long-term memory is not that good, since it seems to have gaping holes. I theorize that the long-term referred to in this case is the time between test dates, which was one week. I definitely have a good memory for some things, especially words and phrases. Math also seems to be no problem, though I seem to have trouble remembering the quadratic equation and a few other simple things from high school. All those triangles with square roots get jumbled in my mind. If you don’t know what I’m trying to recall from geometry, it probably hasn’t affected your life, either. 
Visual working memory, however, was low average. He had the most significant difficulty with the coding pursuit (psychomotor speed with an incidental learning component). This general response is affected by significant reductions with speed/efficiency for new visuomotor learning/task execution, as well as visual working memory. Social judgment skills were additionally below expected.
The preceding is an interesting passage in the evaluation. My working memory (short-term memory) is horrible. I could have told the examiner as much without any test. It is the last line that seems a curious “tack-on” to the paragraph. I assume I said or did something during the block and peg portion of the test that indicated social impairment. I was definitely frustrated with the blocks, pegs, and checklists. There’s little to no chance that I didn’t tell the examiner I found the games annoying. 
On the California Verbal Learning Test-II, a measure assessing the various processes and strategies involved in learning and remembering verbal materials and using a word list format, immediate very short-term recall was more problematic for him, although ultimately he became more comfortable with repetition and cuing. Thus, facility for short and long delay cued and free recall was intact, as well as cued recognition memory. Upon being offered contextually cued material in paragraph format, responses were average for short-term and intermediate pursuits, although, on a recognition basis, some information was lost, the result borderline.
Lists of words were read a various times throughout the evaluation and between other tests I was expected to recite the lists either in order or in related groups. I do recall being more interested in the degrees on the wall and other items in the testing room than I was in the list of words. Why do I care about cucumbers and onions or zebras and elephants? I can tell you that the evaluator attended school in St. Cloud, Minnesota and that the young man in the waiting room during that part of the evaluation was quite ready to go home based on what I could overhear. I definitely lost focus. 
On the oral paragraphs, when presented with college level material, applied decoding was good and short-term comprehension at the 100th percentile. His facility for rapid word list retrieval was diminished, however, at the 24th percentile.
It’s good to know that a college instructor has a college-level vocabulary comprehension. But once again, I did poorly when time was an issue. Clearly, I don’t like to be rushed. Sadly, I don’t recall the vocabulary words. I do recall the two stories that were read to me. Four or five months later, I was still seeing a young man with his first job, excited to be delivering ice cream. Something is really wrong when I can recall images from the stories used in the evaluation but not what I read for class this semester. You probably don’t care about the fishing trip story… but I’m stuck with the images.
In the realm of mathematics, for the most part, S. excelled. His conceptual reasoning was notably strong.
At least I did fine in math skills. I love subjects with clear right answers; math is what it is. Yes, I know there are fields like set theory with more than one zero and strange results for matrices, but math still has rules. Language is changing daily.
After some statistical charts, more observations of the psychologists were included in the documentation. None of the comments were surprising to my wife, but I find myself disagreeing with some of them. My wife believes I’m simply unaware of how I talk or when I tremble. 
Right-sided tremors were apparent, and this condition precluded accomplishing a number of fine motor pursuits. Eye contact was limited, and initially, secondary to anxiety, S. presented with one-word answers. He became more comfortable with time. For the most part, affect was flat and he was nonsmiling, although he ultimately became more relaxed. Prosody was concomitantly unvarying. 
When I read how I’m perceived in the assessment, I do not recognize the person being described. My family certainly doesn’t consider me quiet, and I suppose it is possible that I forget that I tremor slightly until I need to do something requiring fine motor skills of my right hand. As for not smiling, I’m not sure anyone would smile during an evaluation.
Although S. occasionally offered a joke, he seemed to have little perception of humor. His understanding of subtle social interaction and nuance was compromised. For the most part, he enjoyed logic and analysis, being quite literal and, at times, “caught up” in the process of thinking. Some sensitivity to noise was also apparent. 
Maybe I was tense, but at least I tried to be pleasant. I wonder if some of my blunt statements were perceived as attempts at humor, though. I definitely didn’t perceive any humor from the evaluator or the test suite’s content. How funny can intelligence and personality tests be?
If anxiety escalated, extraneous motor overflow became apparent through tapping, pounding, and head tipping. Facility for quickly processing certain types of information was reduced, and there was response latency. Often, S. was quite rigid. He became frustrated when asked to elaborate. When pursuits became more tedious for him, he described distractibility and boredom. 
For the most part, S. was polite and respectful. There was a strong sense of self-deprecation, and he frequently alluded to his poor memory, also describing cognitive slowing (likely influenced by medication). 
Apparently, the noisier the testing center and the more stressful the motor skills test, the more frustrated I became. Feedback loops seem to be inevitable in life: stress causes problems that in turn beget more stress. I didn’t know I tilted or tipped my head, though.
It’s good that I was polite throughout what I considered a miserable experience. I tend to get terse and even rude when I’m doing something I have no desire to be doing. What kept me at the testing center, instead of walking out, was the knowledge that an “official” evaluation was required by the university — the same university that was paying me a fellowship. I also knew it was important to my wife. That’s reason enough to try hard. So, I did everything I could to be polite and complete every part of the test suite. Unfortunately, I wasn’t able to do every part of suite.
Secondary to S.'s difficulty with motor control, a number of motor tasks were omitted from the test battery. For example, with the spelling pursuit, he was allowed to dictate words and a handwritten writing sample was not required. Additionally, secondary to visual and motor issues, he was unable to complete a continuous performance test. The Wisconsin Card Sorting Test could not be accomplished, as he was unable to discriminate colors. 
The challenges with my right arm and other motor control issues would be an issue again during a 2008 medical misadventure. No matter how often I explain that paralyzed is paralyzed, several different psychologists have judged my performance using instruments that in no way accurately reflect my abilities. A physical, lifelong injury limits my arm’s mobility. That does not affect my intelligence, but definitely impairs my ability to write quickly or use a computer mouse with any dexterity. It is beyond absurd to judge my mental state by my physical limits.
I’m only mildly colorblind, but enough that on some computer screens I can’t discriminate between shades of blue and a green. By the time I was asked to sit at a computer and match colors and shapes, I was exhausted. My head was pounding and I just wanted to go home. But, I was willing to at least try the exercise. I politely suggested that I at least try to determine the colors, but the evaluator said that it wouldn’t really add to her findings. 
Generally, S. was highly aware of his difficulty. At the end of the sessions, he commented, “Thank you, I know I’m difficult and unusual to work with.” 
As previously mentioned, before being tested and evaluated, I was given a personality index questionnaire to take home and complete. 
S. completed the Millon Index of Personality Styles, Revised, for this portion of the assessment. He presented as a very cautious individual, avoiding problematic situations and distancing himself from difficult interactions. Generally, he is skeptical of relationships and minimizes his social discomforts. For the most part, he is quite preoccupied with his own inner thoughts and feelings. Life experiences appear to have taught him to rarely depend on others. In order to organize his life and gather information, S. turns inward, drawing inspiration and stimulation primarily from within himself. He prefers to keep his thoughts private and in factual and realistic ways. Thus, he is pragmatic, systematic, logical, liking the unambiguous. 
Occasionally I will sit and watch people, trying to comprehend human relations a little better. I spent a fair amount of time eating alone throughout the years, giving me many opportunities to witness how mean people can be to each other. Even polite exchanges seem to have dozens of imperceptible intentions, all interacting. I’ve mistaken the motives of acquaintances and strangers often enough to know it is better to watch people from a distance than to risk being mocked, teased, or used in a more devious way. 
I don’t tend to make up stories in my mind about what people are saying or doing. I never understood such exercises. If I don’t know what people are saying, what events have preceded an event, or other relevant information, it does not seem right to make up stories. People are more than the moments we witness. I know I’m more than the impression left on most people who meet me. 
He has a strong affinity for immediate, well-documented, and clear-cut disciplines and works at imposing structure on work, as well as personal family life. S. puts duty before leisure. In fact, he tends to react negatively if tasks appear too enjoyable. Becoming lost in minor details and exhibiting rigidity about established procedures and regulations is apparent. S. can lose sight of alternatives of potentially greater value (failing to see the forest for the trees). Usually, he is controlled and narrowly focused. 
Fun is a difficult concept for me. It isn’t that I don’t find some things pleasant or even exciting, but I don’t seem to have a list of things that make me “happy” on a regular basis. I know I like being with my wife, my cats, and interesting books. I have an affinity for water rides at amusement parks, which is hard to explain. I like cool water much more than I like the bumps and drops. Fun is important to me, but I do feel guilty when I take too many breaks.
I always seem to have a long to-do list. I wish I could complete many of the stories, plays, computer programs, and website ideas I have. It often feels like I have never accomplished anything. Maybe I haven’t accomplished much in life. I’m not sure how to measure such an abstract concept as “accomplishment” other than by counting words, pages, or dollars earned. I tell myself the concept of accomplishment is too vague to worry about, yet I feel compelled to do something with my life. This need for quantifiable success frustrates my wife.
Generally, his personality pattern is notable for noncompetitiveness, self-sacrifice, and social inhibitions. S. deflects attention away from himself, underestimating his contributions and achievements. Therefore, he will focus on his worst personal attributes, feeling that he has failed to live up to others' expectations. 
I’ll be the first to contradict the assessment and admit that I am competitive in my own way. I don’t like to fail, and I measure that by social standards and by the accomplishments of those with whom I am familiar. It’s hard to have a lot of self-esteem when you’ve had a series of failures. When I do look at what I have accomplished, it doesn’t seem like those things were particularly difficult or worthy of praise. Even as I consider commenting on the evaluators’ words, I think they are mistaken — I don’t have any achievements and I’m not clear on what my contributions to society are.
There is definitely a duality to my personality when it comes to achievement. I know that standardized test scores, IQ tests, and grades measure something and indicate a level of competence; at the same time I wonder what that competence does for society. The moment I start to think of myself positively, I critique the things giving me an implied value.

Comments

  1. I'll be purchasing your e-book and reviewing it on my website when I am finished reading it. I'll come back and give you a link to the review when I'm through.

    ReplyDelete
  2. Keep in mind the first book is merely an overview, because I wanted to stop at 50,000 words. I also wanted the $2.99 cheapest price allowed on both major sites: BN.com and Amazon. You can't charge less on one than the other, or they won't let you post the book. (Amazon would let me post for $0.99 otherwise. A dollar would make the book more available to people, but I wanted to offer a Nook version. I love the Nook.)

    The book I am currently posting is going to be much longer, but it offers no particular advice. It's a memoir, and that's all it is. Not sure what people will or won't gain from it.

    ReplyDelete

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