Tag Archives: Testing

Psychological Evaluation

Last week, I would’ve had my ten year Aspieversary/autiversary or the anniversary of my autism diagnosis. I did realize this and even started writing a blog post about it, but it didn’t feel right to celebrate an anniversary of something that no longer is. After all, I’m no longer diagnosed as autistic. I was also quite shocked when it dawned upon me that I’d been institutionalized for almost the entirety of these ten years. I then started thinking about the ten years before that and how much longer they seemed to have taken. Time flies when you’re getting old(er).

I then started writing a post on the psychological evaluation that I had the day before my would-be-Aspieversary. That was hard too – both the evaluation and writing about it. For the first time that I had a psycholoigical assessment, the personality testing was in fact the easiest – or least difficult – part. I just can’t get past the fact that I did rather poorly on some of the neuropsychological tests and didn’t seem to score as great on the intelligence test.

The neuropsych testing consisted of a couple of memory tests. Most went okay, but with one, I kept losing focus. Then there was a test for semantics, the way words and their meanings are formed and articulated. I had to name as may words starting with a given letter or in a given category (animals, occupations) in one minute as possible. In the animals category, I started blurting out donkey, squirrel and Brazilian wandering spider, which are three words I use repetitively, and then I got stuck. I don’t know what the average score is of course, but some of my staff tried this one and did much better than I did. Of course, they weren’t in an actual test setting.

Then I got what I think is the verbal part of the Wechsler Adult Intelligence Scale. Older versions of this intelligence test consist of a verbal and a non-verbal (performance) part, but the performance part isn’t possible for me because I’m blind. The current version does not provide a verbal or performance IQ score, but it still consists of verbal and non-verbal tasks. I did okay and still seemed to have the same strengths (similarities, arithmetic) and weaknesses (compreheension) as when I last had an intelligence test twelve years ago. I don’t think I scored as mind-blowingly high as my parents would want me to though. When I told my mother so, she said I just don’t want to know that I’m gifted. I don’t know whether she meant that I didn’t try my best or that I underestimated my actual performance.

I also got some tests that seem to be specific to autism. One of them was a kind of weird test that seemed to measure theory of mind. I heard these little stories and then had to say whether a character had said something inappropriate. Then there were follow-up questions abou thow each character would feel, whether they could know that what they said was inappropriate, etc. I got rather frustrated with this test.

Some of the questionnaires also seemed to be relevant to my possible autism. One was some kind of systemizing/empathizing test. I once took a similar (or the same) test online and scored below-average on both scales. I mean, I am interested in systemizing, but I can’t actually do it right in daily life. For example, I can’t balance a checkbook, but I do take an interest in random strings of information, such as share prices (yes, I did at one point perseverate on that). There was also this test that asked about the ability to read one’s own feelings. This was a rather weird one to me, but that may be because I barely understand how anyone would be able to tell the difference between for example feelign excited and feeling enthusiastic.

Lastly, I got a coping sytles questionnaire and several personality tests. I scored high on avoidance twelve years ago when I got the same coping styles questionnaire and I think that has only gotten worse. After all, all I’ve learned in the mental hospital is to distract or take a tranquilizer. This is the worst coping style according to my college psychology professor. I did okay on the personality tests. I mean, it’s likely I have at least some personality disorder traits, but that’d show in my behavior too anyway.

A week has gone by since the psychological evaluation. My husband had to fill out another questionnaire about me again over the week-end. It was some kind of executive functioning questionnaire and I felt rather awkward at how many boxes my husband ticked. I also got a call from the student doing the evaluation on Monday with one more questionnaire. It seemed to be the other half of the systemizing/empathizing thing. I got to do that over the phone. The student also asked for my E-mail address, so that the psychologist could contact me regarding some questions and concerns I had written down and taken to the assessment.

I have mixed feelings about the possible outcomes of the assessment. I mean, I don’t even know whether I want to be autistic after all. Of course, you’d think, most people wouldn’t choose to be autistic over neurotypical. That’s not what’s at stake here though, since I won’t change neurotype if the psychologist diagnoses me one way or the other. I still think I need the validation that my impairments are real. Realizing these impairments makes me feel a little inferior to the people I love, and in that sense, it’d be great if I made them all up. Of course, that may be internalized ableism.

Test Scores Don’t Determine Ability to Get By in Life

On a Dutch blog by the mother of a child with autism, I read about the impact of IQ on school choice. The child in question is intellectually disabled. I am not. However, I can totally relate to measured IQ impacting the choices made for me regarding my education.

I have a verbal IQ that was at one point measured at 154. I have had many IQ tests other than this one. I didn’t score as high on all. On one, I didn’t even score within the gifted range. Nonetheless, my IQ score of 154 is mentioned in every diagnostic report about me.

This is a verbal IQ. IQ is composed of two components: verbal and performance. My perfomrmance, or non-verbal IQ cannot be measured because I’m blind. This doesn’t mean it doesn’t impact me. Professionals involved with autism have consistently suspected that my performance IQ is significantly lower than my verbal IQ and this could be one reason my abilities are constantly overestimated. It cannot be measured, however, so let’s just continue expecting excellent, or at least good performance out of me. Or not.

The mother writing the blog I mentioned above desperately wanted her child to have an IQ above 70 so that he could go to a school for children with behavioral disturbance rather than a school for children with an intellectual disability. In my own case, my parents desperately wanted me to score high so that they could convince the special school for the blind to recommend me to regular education. Finally, they needed not just to prove that I am intellectually capable, but that I excel academically, because they had decided I should go to grammar school. I had to have a standardized test score above a certain number and thankfully I scored within the expected range. The special school principal called my parents in total shock, because she didn’t have a clue that I was this capable.

In real life, unfortunately, it takes more than academic excellence to excel, or even to get by. It takes more even than a high verbal IQ. More than a high IQ in general, in fact.

Why do people rely so heavily on test scores to determine what they can expect out of someone? Because my abilities are consistently overesitmated, the autism consultant recommended further testing to determine why I function at a much lower level than my (verbal) IQ would suggest. My psychologist dismissed this idea. I understand, because it takes a lot to be able to assess someone who is blind. Besides, I’m not so sure I’d be able to take yet another exam, as that’s what it feels like.

Why don’t we just understand that people are different? People have different abilities and difficulties and they shouldn’t all have to be Einsteins or prove why they’re not. Yes, I know Einstein is sometimes suspcted of having had practically every neurodiverse codnition under the sun. I don’t care. My point is that, if someone doesn’t get by, they need help and it doesn’t matter whether a test score says they should be able to get by.

#DearSoandSo: Psychological Evaluations

Dear evaluating psychologist,

You don’t know me yet. Soon, you’ll know me as the blind, autistic person who was born prematurely. Then, you’ll hopefully get to now me as Astrid. I was referred to you by the autism center’s consultation team for neuropsychological and intelligence testing.

You need to know that I am a survivor of psychological trauma. I won’t disclose any details, but it’s important that you know that psychological evaluations are a big trigger for me. They are very intimidating. As a result, I might dissociate and put on a mask, which might influence my performance.

I ddon’t know how exactly to prevent myself from dissociating or putting on a mask. I also don’t know for sure what you can do to help me. However, I would suggest you refrain from making assumptions about my performance prior to or during testing. I will try to remember that I’m still me with my abilities and difficulties, regardless of the outcome of testing. However, this is hard to remember.

I hope that the testing experience will be as stress-free as possibe. Thank you for any help you may be able to provide.

Kind regards,

Astrid

I went to the country’s top notch autism center, which happens to be in my town, yesterday. They thankfully believe I’m on the spectrum and don’t see a need to re-evaluate me. They however recommended intelligence and neuropsychologcal testing to find out why I function at a much lower level than my verbal ability would suggest.

They also recommended a sensory processing evaluation. I have suspected I have sensory processing issues for a long while, but now that I think on it, I may ask specifically about auditory processing. I used to be seen as an auditory learner (probably because my tactile skills were worse), but I still have a lot of difficulty understanding speech when there’s background noise. I also tend to process speech with some delay it seems. For example, I’ll say “What?” and then realize I did hear what was being said. Some people in the sensory processing disorder community said that auditory procesisng is different from sensory integration, so I’ll have to ask specifically about this.

Lastly, they recommended a support worker come to visit me at home and in the institution to establish my independence and support needs. Then, they could help me develop greater independence skills.

Dear So and So at Mummy from the Heart

Extreme Male Theory of Autism #AtoZChallenge

Welcome to day 24 in the A to Z Challenge¬†on autism. Today, I have cheated a little because my word for the X post doesn’t really start with an X. Then again, many bloggers participating in the challenge choose words for their X posts that start with “ex”. Today’s topic is the extreme male theory of autism. I might even try to find something on genetics so that the X and Y chromosomes, which determine a person’s sex, will be involved.

As I said yesterday, autism spectrum disorders are thought to be more common in boys and men than women and girls. Leo Kanner concluded this already in his initial study of autism in 1943, and Hans Asperger initially thought that the condition he described only affects males.

Not only is autism, and particularly Asperger’s Syndrome, still thought to occur more commonly in males than females, but researchers also believe that there is something “male ad then some” about autism. Asperger himself wrote that the boys he described might display something that is akin to a more extreme variant of male intelligence. Simon Baron-Cohen, an autism researcher in Cambridge, has therefore developed a theory by which autism is described as an “extreme male brain”.

Compared to females, even typically developing males have strengths in mathematical and spatial reasoning and weaknesses in social judgment, empaty and imaginiative play. They are also at a higher risk for delayed language development.

Baron-Cohen and his colleagues have developed a model to test their theory which divides the way the brain operates into two major areas: systemizing and empathizing. Systemizing refers to the drive to analyze or construct systems, whereas empathizing refers to the drive to understand other people’s emotions and thoughts.

The extreme male theory of autism views people with autism spectrum disorders ans hyper-systemizers. They are very much interested in non-human, rule-bound systems. This might seem like an idea that only applies to higher-functioning autistics, but it is thougth that in lower-functioning autisticcs, hypersystemizing might show itself in for example collecting and organizing buttons or suchlike.

On the other hand, autistic people would show weaknesses in social judgment, such as figuring out social cues, understanding what another person is feeling and grasping social hierarchies.

There is a theory that says that higher testosterone (male sex hormone) levels while in the womb lead to a more male-like profile on the systemizing-empathizing dichotomy, ie. higher systemizing scores and lower empathizing scores. Lower testosterone levels in the womb are thought to lead to a more empathizing-oriented brain style. This however has not been proven to explain autism. Further research in this area is needed.

Do you want to know whether you’re more of an empathizer or a systemizer? There is a test which gives you a score on both of these scales. My own empathizing score was 20 while my systemizing score was 30. Both are below-average.

Intelligence and Autism #AtoZChallenge

Welcome to another day of the A to Z Challenge on autism. Today, I will discuss autism and intelligence.

First, what is intelligence? Intelligence is generally defined as a person’s overall cognitive ability across a number of domains, such as verbal comprheension, perceptual reasoning, working memory, etc., as measured by standardized IQ tets. Examples of IQ tests include the Stanford-Binet test used mostly in the U.S. and the Wechsler scales used more in Europe.

An average IQ score is 100. IQ follows the bell curve by which, the further a score deviates from average, the fewer people have this score. The standard deviation used on IQ tests is 15 on the Wechsler scales. This means that an IQ of 70, which is defined as the cut-off for intellectual disability, is two standard deviations below the norm. Approximately 2% of the population have an IQ below 70.

On IQ tests, the score is usually divided in a verbal commmponent and a non-verbal or performance component. Autistic people commonly have a gap between their verbal and non-verbal intelligence quotient. Some non-verbal autistic people show a dramatic increase in their IQ scores once they learn to type. Other people, usually diagnosed with Asperger’s Syndrome, have a high verbal IQ but a lower or even below-average non-verbal IQ.

It used to be thought that autistic people usually had a low IQ or intellectual disability. Current estimates are that approximately 40% of children with autism spectrumd isorder also have an intellectual disability. Children diagnosed with Asperger’s Syndrome by definition do not have an IQ below 70. However, some people with Asperger’s score as borderline intellectual functioning (IQ between 70 and 85) and may benefit from services for people with an intellectual disability.

IQ may be a predictor of how capable a person will be of becoming independent. However, other factors play a role too, such as adaptive functioning. Young children with Asperger’s usually do not have problems with self-help skills or adaptive funcitoning (other than that required for social interaction). However, as children mature, more problems with adaptive functioning in general may arise. I unfortunately have never had an assessment of adaptive functioning, so I don’t know how I’d score. However, people are usually surprised at my ability to use the computer but not, for example, cut up my own food or take proper care of my personal hygiene without prompting.

Diagnosis: Finding Out About Autism #AtoZChallenge

Welcome to the A to Z Challenge, day four. Today, I have a bit of a personal post for you. I am going to share what it was like for me to get diagnosed with autism. My experience will hopefully empower adults who suspect they are autistic to make the right choice for themselves.

First, I was “self-diagnosed” for several years at around age sixteen. I didn’t like the term “self-diagnosis” at the time, because I didn’t feel a layperson (or even a professional) could diagnose themself with autism or any such condition. I’d rather say that I suspected I was on the spectrum.

My father’s comments both caused me to start suspecting I’m autistic and to stop suspecting it again – at least openly. One day in June of 2002, he came to my room at night yelling whether I was autistic or something (in the tone of voice that parents use to discipline their children). I wasn’t sure what being up late at night playing music, which bothered my father, had to do with autism, but somehow soemthing clicked with me. Maybe I was autistic after all.

A little under two years later, my father read me a newspaper article on fashionable disorders like PDD-NOS, and said he knew I had one of those conditions too: I had an asparagus addiction (bad wordplay on the pronounciation of “Asperger’s”). I decided that day that I wasn’t autistic after all.

Many adults nowadays suspect they are autistic long before they get formally diagnosed. There are many reasons why a person might seek a formal diagnosis, such as:


  • Getting professional confirmation of their suspection.

  • Having less trouble getting accommodations at work or in school (they can prove that they have a disability and are protected by the ADA or similar laws).

  • Getting disability-related services, such as independent living support.

  • Being able to pursue treatment.


There are also many reasons why people might decide not to seek a formal diagnosis and stay self-diagnosed. For example:

  • They may have negative experiences with psychiatrists, psychologists or other healthcare professionals, whom they will need to see in order to get diagnosed.

  • Some people don’t view autism as a disorder, so don’t believe they need to be diagnosed with it by a mental health professional. They just know are autistic.

  • A diagnosis may lead to an increased risk of discrimination, for example for health insurance or in employment situations.

IN late 2006, I myself was pretty much falling apart and hardly able to function in the independence training home I lived at. It wasn’t my decision to get me formally diagnosed, it was the staff’s. In fact, I couldn’t communicate to my GP that I wanted a referral to mental health services. It wasn’t even until the staff said they were wanting me to be assessed for autism that I started believing I might be autistic after all again.

The process of getting diagnosed may vary depending on the person’s age, cognitive ability, etc. In my case, for my first assessment, I had some meetings with a psychiatrist and then my parents were asked to come over to answer questions about my early development. If parents aren’t available, a sibling or other relative who has known the person being assessed for a long time, will be asked to complete this assessment.

Because the paperwork got lost, I had to be reassessed half a year after my initial diagnosis. This assessment consisted of the AQ-test (which stands for either autism quotient or autism questionnaire). This is a fifty-item questionnaire which asks about autism symptoms. I do not feel this questionnaire is worth much, as it can be completed by anyone online and someone who’s suspected they have autism for a while, can easily answer the questions in their favor. I also had to complete a DSM assessment. The DSM is the psychiatrist’s manual with criteria for each disorder. In a DSM assessment for autism, they walk you through the criteria and ask you to explain whether you meet them and if so, why. Lastly, my parents had to complete a developmental assessment again.

For a reason unbeknownst to me, I had to be assessed yet again in 2010, three years after the second assessment. I was this time given the AQ-test again plus the Dewey Story Test and something similar to a DSM assessment. The Dewey Story Test is a test of social awareness. It consists of a number of scenarios about human interaction. The person being assessed has to rate the person’s behavior at certain points in the scenario, with ratings ranging from “normal” to “shocking”. This test, too, at least used to be available online, though I can’t find an English version right now. I scored quite poorly on this test and again scored high on the AQ-test.

Other elements of an autism assessment might include IQ testing, neuropsychological testing or specific observation or interview instruments for diagnosing autism. An example of this is the Autism Diagnostic Observation Schedule (ADOS).

Unfortunately, the paperwork from my second diagnostic assessment, which was the most comprehensive, got lost last year too. Because I am going to get a consultation at the country’s top notch center for autism, I fear I’ll need to be assessed once again. This is because they require a clinical psychologist’s or psychiatrist’s diagnosis and the third assessment was by an educational psychologist. Besides, my parents weren’t asked for a developmental ssessment this time, because firstly they wouldn’t want to come over again and secondly I didn’t want them to. Unfortunately, because I badly do need services and treatment, I have no choice but to get reassessed if that’s what they want.