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Ask Dr. Ed Wilfong Your Own Question

Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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My son has been diagnosed with subcortical dysfunction, ADHD, Mild Neurocognitive Disorder

Resolved Question:

My son has been diagnosed with subcortical dysfunction, ADHD, Mild Neurocognitive Disorder, and Temporal Lobe Disorder. Can you explain this in laymans terms? Especially in terms of behavior.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Ed Wilfong replied 3 years ago.

Dr. Ed Wilfong :

These are essentially (not exactly) saying the same things. In terms of his behavior, they are saying his ability to control, especially inhibit unacceptable behavior, has been impaired at the level of the brain, specically the frontal cortex which controls impulse control. Secondly, there is like widespead but minot, almost random, deficits in different parts of brain that can interfere with attention, behavior, learning. These are usually so diffuse and a result of "something missing" that neurological scans cannot see damage, must testing different strengths and weakness of certain functions (attention, concentration, planning, spacial relations, and many others) will show a pattern of impairment in some areas.

Dr. Ed Wilfong :

Medications, in these cases, can often be effective in helping with attention, but otherwise it is difficult to control some of the behavioral sysmptoms --- acting impulsively, potential violence, poor judgement. The medications often are uncomfortable and sedating and he may subjectively feel better, but he is at risk for acting in ways that are more self/other dangerous. The medications can "control" some of systoms, but are not curative.

Dr. Ed Wilfong :

He may also have difficulty with spatial and time relationships.

Dr. Ed Wilfong :

Sometimes epilepsy occurs with temporal lobe dysfunction, but you should know if it does by now.

Customer:

So there is no cure. I have started researching this again due to recently re-reading a psychological study completed when he was 16. One thing that caught my eye was that Mild Neurocognitive Disorder was often the result of brain trauma. He did receive a blow to the head at sometime between 1992 and 1997. I would have to dig deeper to get the actual date. Could this be the cause? He was diagnosed with ADHD at age 5.

Customer:

He has had seizures, don't recall the exact name, but they occur in his sleep, mild jerking, and no memory of it on waking.

Dr. Ed Wilfong :

If there was injury that was the cause, any seizures should be controllable with mild medication. They may also be myoclonic jerking, which is bodies attempt to wake self. I would have to see whole report. The ADHD (without doing math) could be seperate and treatable. Don't take the term "no cure" to seriously. We can actually "cure" very little. Typically, the problems can be controlled by medication, but re-occur without it. The "Neurocognitive Disorder" as a result of injury makes sense as being a result of trauma, but the term itself is too vague to know what is meant by it.

Customer:

"The DSM IV diagnostic formulation of Impulse Control Disorder NOS does not appear adequate for the breadth of his cognitive variations and therefore a diagnosis of Mild Neurocognitive Disorder appears appropriate." This is a quote from the report prepared by Dr. Wylie, Clinical Neuropsychologist.

Dr. Ed Wilfong :

That makes sense, that the damage from injury would exceed what one would expect from just an impulse control disorder. He is saying the impairments in thinking and behavior are more than "Impulse Control Disorder", but the report should also tell you what the impairments are. I did not know about injury (an important fact) where when I first replied. Still treatment would like help control some of the impulsive behaviors but "mild Neurocognitive Disorder" only tells me there is a problem in his thinking, not what it is.

Customer:

Without retyping the entire report I think that I should try to determine the exact date of the head trauma, which at the time was really no big deal, a bump on the head and 8 stitches. If the timing of this correlates to the onset of the aggressive, threatening behavior, refusal to go to school, angry outbursts, etc, it might explain, especially for him, the 'why'. My goal here is to help my son understand that he is not evil or bad but . . . . .

Customer:

I just put two and two together regarding the head trauma when researching today to better understand this report. All the prior testing etc has been dug out, reminding me of just how awful those years were, because he is reapplying for SSI.

Customer:

He has been unable to keep a job. But, when he is interested in something he pursues it and gives it his full attention.

Dr. Ed Wilfong :

No, he is not bad and SSI is good idea. He will need re-evaluation and good attorney. Subcortical implies the damage is deep under the cortex. The cortex is the conscious thinking part of brain, subcortical implies more instinctual, beyond conscious control functions. SSI is always a fight, so be prepared. Lawyers.com is good site for finding attorney. SSI typically denies 1st 2 applications and approves once attorney has it and it goes to court. The key is not to give up. He is not a bad guy. Sometimes brain heals from early injuries, sometimes not. It is his functioning ability that will decide case. Here is a bit of trivia regarding lawyers and SSI. They are paid a flat fee (there is a set amount) taken out of how much government owes i BACK PAYMENTS, so attorneys will let the court clock run until there fee amount piles up to limit (about $5k, which can take a while).

Dr. Ed Wilfong :

I hope you can accept my answer so I get paid for my time.

Customer:

thank you, XXXXX XXXXX very informative.

Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience: Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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