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    #248009 02/10/21 09:03 AM
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    Just wondering if anyone is being pushed by the school to consider autism? We are not seeing those signs at home (other than high energy). He is happy, friendly, outgoing, varied interests, but silly and emotional sometimes. Is it possible that that the higher giftedness scores would contribute to some of the behaviors? PSI and working memory seem to be higher than average (although PS relatively lower, but still in gifted range). How often are these kids misdiagnosed?

    WISC-IV 2017 (age 7): FSIQ=142 (GAI=141) --- VCI=155, Visual Spatial=128, Fluid Reasoning=132, WM=146, PS=115

    WISC-IV 2019 (age 9): FSIQ=152 (GAI=153) --- VCI=155, Visual Spatial=128, Fluid Reasoning=155, WM=133, PS=124


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    My son was misdiagnosed with autism (Asperger's) when he was 9. His actual issue was being HGish with dyslexia. The person who diagnosed Asperger's thought his interests were odd. He was "undiagnosed" at age 10.

    He is now 24 and very obviously not autistic.

    There is an interesting discussion of this issue in the book Misdiagnosis by Webb and colleagues.

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    I assume those are both WISC-Vs and not -IVs. Has any professional discussed extended norms with you? Your child clearly attained max subtest scaled scores on at least four subtests (both VCI and both FRI) on the second administration, which suggests that the index scores are low estimates. And that the Index differences may actually be much wider than they already appear to be.

    And from what I can see, the VSI subtests were pretty consistent within the cluster, (as were, obviously, the VCI and FRI subtests) which suggests that the VCI/FRI > VSI difference is real. Which leads me to the construct of nonverbal learning disorder, which, while not a formal diagnosis in the DSM or ICD, can have some utility in understanding certain profiles where language-based skills are much stronger than visual spatial/nonverbal skills. I bring this up not to stick another label on, but because there is a fair amount of overlap between the presentation of persons on the autism spectrum and persons who could be described with the NVLD model. In this case, of course, this would be more of a relative weakness (or strength, in the other direction!). There is a long-standing discussion based on clinical observations regarding NVLD vs ASD, as both may involve some subset of: rigidity/resistance to change, anxiety, difficulties with reading social situations (or face-blindness), and executive function challenges. The principal distinction would be in the presence or absence of theory of mind (perspective-taking), and in how that contributes to differences in social perception. It is hypothesized that in NVLD, misreadings of social situations occur because of relative weaknesses in visual-spatial perception-- difficulty perceiving the visual cues that help NT observers interpret social behavior. In contrast, in ASD, difficulty reading social situations arises from limitations in theory of mind/perspective-taking. The visual cues are accurately perceived, but the observer does not automatically respond to the emotions with which they are usually associated. (Side note: some interesting research on mirror neurons, in this context and others.)

    If we were to consider an application to your DC's case, it would be to discuss whether what the school perceives as ASD-ish is some of the social and emotional presentation often associated with NVLD-type profiles. Remember that there is no core social comprehension deficit in NVLD. Just relative weaknesses accurately reading nonverbal communication at speed, and the sequelae of those misperceptions. So it's not incompatible with a happy, social, outgoing child, especially when in relaxed, familiar environs.

    BTW, the high energy may sometimes be related to the profile, too, because less efficient processing of visual spatial input means that less incidental environmental sensory stimulation is making it into the system, which can lead to stimulus-seeking behavior (aka, high activity level). It's not unusual for this profile also to be misdiagnosed (and sometimes mis-medicated) as ADHD.

    If you feel comfortable posting subtest scores, we can see if there's anything more to be gleaned from them, but from what I can see, unless there's a marked difference within the WMI or PSI (e.g., at least 3 scaled scores), or inside the Digit Span component scores, that's probably not necessary.


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    Originally Posted by Portia
    The reason I say to be careful is because the medical records from ages 3-7 have the HFA diagnosis. Even though we have documentation stating the HFA was a misdiagnosis, I cannot get it removed from the medical records or no longer considered a valid diagnosis.

    This is a very good point. My son was diagnosed before the Affordable Care Act, and back then autism was considered a preexisting excludable condition. I actually knew someone whose insurance company frequently tried to deny coverage because of her son's autism diagnosis even when the visit/treatment was very obviously not related to his autism (like going to the doctor for the flu).

    There are other issues as well. For example, I believe that the military excludes folks with an autism diagnosis.

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    YES it was WISC-V (not WISC-IV). Sorry I just figured out that there were responses to this post!!! How great! Here are the Ancillary Test Scores (subtests to follow):

    WISC-V Ancillary Index Scores:

    Non-Verbal = 145 (99.9)
    GAI = 153 (>99.9)
    Cognitive Proficiency = 134 (99.9)


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    Here are the subtest scores:

    Verbal Comprehension:
    � Similarities 19
    � Vocabulary 19
    � Information 19
    Visual Spatial:
    � Block Design 15
    � Visual Puzzles 15
    Fluid Reasoning:
    � Matrix Reasoning 19
    � Figure Weights 19
    Working Memory:
    � Digit Span 17
    � Picture Span 15
    Processing Speed:
    � Coding 14
    � Symbol Search 14

    AEH, interesting feedback re: the potential non-verbal learning disorder. I have not heard of that but will look into it! He did score well on the non-verbal ancillary test (145) associated with the WISC-V test. But he does seem to clash socially with certain kids at school (in terms of overreacting to situations) and may indeed have difficulties reading the room. Not extreme and we don't see this at home though.

    And his handwriting is atrocious...but he is a demon on the keyboard.

    Re: "Extended norms" - The tester did mention that the scores may be an underestimate as he received the ceiling (19) in a few sub-test categories, but is it really important to take the extended testing? Do you think it provides additional insight or not worth the time?

    THANK YOU!!!

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    Interesting... I hadn't thought of the implications of a diagnosis appearing on his permanent record. I had wondered if they were pushing a diagnosis to obtain additional funding for the school.

    aeh #248036 02/19/21 10:24 AM
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    Wow - just looked up NVLD and there are quite a few similarities! He is very good at math though (>99.9th) and Reading (>99.9th) based on WIATT III. But yes on the facial cues, motor skills, etc....will have to dig deeper into this. Thank you SO much!!!!

    Here are the subtest scores form the most recent WISC-V:

    WISC-V Ancillary Index Scores:
    Non-Verbal = 145 (99.9)
    GAI = 153 (>99.9)
    Cognitive Proficiency 134 (99.9)

    Verbal Comprehension:
    � Similarities 19
    � Vocabulary 19
    � Information 19
    Visual Spatial:
    � Block Design 15
    � Visual Puzzles 15
    Fluid Reasoning:
    � Matrix Reasoning 19
    � Figure Weights 19
    Working Memory:
    � Digit Span 17
    � Picture Span 15
    Processing Speed:
    � Coding 14
    � Symbol Search 14

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    I'm not surprised he's good at math, given his FRI and WMI, which are generally the best predictors of math achievement. In his case, the effect would probably be more focused on the face reading, and maybe, eventually, in geometry (but maybe not, since his fluid reasoning is so strong, and his spatial abilities aren't really weak, just relatively so).

    And the NVI is of course quite strong, but we are really speaking of relative weaknesses here, not absolute ones. (And remember that two of the contributing subtest scores are the 19s from FR.) His NVI is also ten points lower than his VCI (which may well be an underestimate), and may be even more discrepant from the Extended VCI.

    You do not need to do any additional testing to compute the extended index scores, if the examiner followed standardized administration procedures. All you need is the raw scores from the five subtests that reached max scaled scores. And the norm tables, of course, but your evaluator has those (they're also freely downloadable from the publisher's website, but I'd recommend having a qualified person doublecheck the conversions, and whether the recalculated scores are meaningfully different).

    It's a lot harder to reach automaticity in handwriting than in typing. Wider range of complex fine motor skills. And a lot of extra initiations and placements, for every word when using cursive, and for every letter when using manuscript. That can be tough for learners with relative weaknesses in visual spatial skills, automaticity (represented here potentially by the relative weakness in PSI), organization or some combination thereof. Fortunately, it really doesn't matter much anymore, in the real world. Type away!


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    Just a bit of caution, any physician or mental health professional "can" diagnose autism, but shouldn't without specializing in it. There are so many overlapping conditions/variables, OCD, child abuse/neglect, giftedness, ADHD to give a few. A similar example, as a mental health professional, I cannot tell you how many parents come to me saying that the school has said their kids have ADHD, when it is something completely different (most often intellectual capability that doesn't match what school teaches to). The school is not qualified or trained to push that, if you are concerned, I would ask your physician for a referral to a specialist.
    Some things I would look for is how do they seem to engage with people that they can connect to (which may or may not be their classmates), eye contact, early childhood development, repetitive behaviors, etc. There are so many similarities between giftedness and autism, it's important to rule those similarities out.

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