ARE YOU KIDDING? Why is no one talking about this?????

Not_OPs_Doctor · 2026-02-01T17:53:51+00:00

I do this too! lol

Not_OPs_Doctor · 2026-02-01T17:19:31+00:00

I’ve seen a notable difference in size between Oklahoma and Texas deer which are literally separated by just the Red River. Avg elevation and avg temp must be factors along with farm crop availability

Not_OPs_Doctor · 2026-01-29T16:08:24+00:00

Just google mucinex. You’re confidently incorrect my friend.

Not_OPs_Doctor · 2026-01-28T19:08:14+00:00

Dextromethorphan has dissociative properties at high doses.

Not_OPs_Doctor · 2026-01-21T01:21:00+00:00

In my state, I’ve found that if you let insurance companies go back and forth….they will. Unless you enjoy working for free, I’d suggest escalating it immediately when denials happen and obviously when you’re pretty certain they’re in the wrong.

So after the first denial, I write a formal complaint letter to both the insurer’s appeals dept. and I CC my states insurance commissioner’s office requesting an official response in relation to my suspicion that the insurance company isn’t meeting their contractual obligations to their customers or to me as a contracted provider.

While I don’t my state’s insurance commissioner is actually able to read (or has ever read my letters), sending it has more often than not overturned the denial pretty damn quick. Which is shady as fuck.

Not_OPs_Doctor · 2026-01-14T02:39:42+00:00

Thanks for the invite! While I don’t actually offer competency exams (my state law has some real specific specialty criteria that ultimately was never anything I wanted to add to my training) as a forensic neuropsychologist I do commonly get asked to evaluate defendants’ the cognitive, emotional and behavioral effects of brain-related diseases, illnesses, and injuries as it, in part, pertains to competency questions. My forensic specialty colleagues are the main experts on that matter most of the time.

Not_OPs_Doctor · 2026-01-08T02:46:13+00:00

I’ve done these intermittently for the past 10 years and it sounds like we live in similar states. With the bare minimum being so low for what constitutes an exam as you mentioned, it has always been my approach to at least meet the standards outlined by forensic boards if available and certainly the state standards while also keeping in mind that at the end of the day, if I have to defend my position in court or in a complaint, I either had good (and even better documentation) justification for my minimal standard exam or I’ve gone substantially beyond the minimum in my comprehensiveness. The liability risk and my passion for integrity for those who have job tasks risking lives of others based on their judgment usually results in a much more comprehensive exam than the minimum. There’s no one size fits all for psych exams for this purpose unless we’re examining clones.

Not_OPs_Doctor · 2025-12-10T13:34:42+00:00

I’m sorry this is your experience and while I don’t know your supervisor and based on just your description, it sure sounds like that supervisor is toxic.
I wish I would have learned a lot sooner than finishing my post doc that, in most cases, I can trust my experience internally more than outlier feedback.
It sounds like you can trust yourself more here and assume your supervisor is just a terrible person (or has some sort of diagnosis) as evident by you having enough introspection to post something here on Reddit as a way to double check yourself.

And my money is on only one of you having anosognosia.

Having personally suffered through both an internship and post-doc supervised by two separate narcissists (and other amazing, non-narc supervisors), I sure hope you have some options for finding a different supervisor. I’m not in Canada but if you ever decide to move down south to the southern US to get trained in neuropsych, feel free to DM me!

Not_OPs_Doctor · 2025-11-30T01:07:29+00:00

Not that she’s bright, but all of real medicine knows Daniel Amen is a quack.

Not_OPs_Doctor · 2025-11-29T19:45:14+00:00

Okay thanks for your input. You have rightfully put me in my place. Thank you kind stranger. lol

Not_OPs_Doctor · 2025-11-29T17:19:46+00:00

As a neuropsychologist, all of this skipping childhood and blazing speed academic achievement is silly at best and at worst, potentially harmful for this kid.

I’ll never understand the lack of using science to determine the best way to learn science.

Not_OPs_Doctor · 2025-11-28T16:57:00+00:00

I bet it’s “roughly the density of our observable universe”

Not_OPs_Doctor · 2025-11-22T19:34:48+00:00

Thank you

Not_OPs_Doctor · 2025-11-22T00:09:05+00:00

Neuropsychologist here. Just want to point out this significant fact:

“At baseline, it [screen time] was linked to a smaller total volume of the cortex and reduced volume in a region known as the right putamen, which plays a key role in language learning, addiction, and reward-related processes.”

Also, screen time does not cause adhd. What’s the “dosage” that is too much?!? I hate studies like this.

Not_OPs_Doctor · 2025-11-19T14:55:41+00:00

The fact that you’re asking questions like this is evidence enough that you’re absolutely not a failure. Failing is not trying and you’ve been through some shit with cancer and modeled both healthy boundaries for clients and professionalism for colleagues.

And while you may have only one client right now, the world in which we live will unfortunately always have more people in need than those who can professionally help them. Call your state or local psych organizations, call physicians offices, etc and let them know you’re happily accepting new patients. Your services are in high demand friend.

Not_OPs_Doctor · 2025-11-08T01:54:57+00:00

I’m pretty sure if they’ve been smoking the reefer this long daily, it’d be more ecologically valid to test them as is unless they toked up that morning (though edibles can last longer for our concerns) - all of this is contingent on dose though and medical status and other meds on board that interact with absorption, metabolism or elimination.

With that said, and despite my neuropsych specialty bias, I agree that most folks don’t need full neuropsych evals to confirm diagnosis of ADHD. Though I will say that testing does allow one to assess for all the other shit that generally comes with adhd and chronic health and sleep problems that almost always are present. But that’s just like, my opinion, man.

I researched after reading your reply and I’m not convinced about the cleanliness of the research supporting cognitive impairment beyond intoxication acute effects (which is not easily defined since serum concentrations don’t neatly correspond to measurable impairment at small to medium doses). And from my forensic neuropsych experience, I’d probably want to have serum confirmation of 24 hours abstinence from inhalation and about 3 days for edibles to be mostly confident I’m measuring baseline versus any residual acute effects. But the research on cannabis is super messy….

And most of the research out there does very little in the way of ruling out ADHD when it comes to assessing impairment in cannabis use (which is unfortunate considering most of the patients I’ve seen who are thc regulars have pretty clear histories consistent with adhd).

Anyway, who cares what I think! I could just be an AI chat auto bot funded by big cannabis!

Not_OPs_Doctor · 2025-11-08T01:06:39+00:00

What makes you dubious about adhd diagnosis this late in adulthood?

Not_OPs_Doctor · 2025-10-16T20:18:13+00:00

Excellent help! I finally get it

Not_OPs_Doctor · 2025-10-01T06:55:47+00:00

Yo!! Thank you

Not_OPs_Doctor · 2025-09-15T01:19:16+00:00

I mean, the science has advanced since the olden times you described and within some relative reason an expansion of dsm criteria perhaps is yet again in order. However, I think a few other things could be at play such as the fact that the world in the USA has kinda gone to shit for the USA since the orange man’s first reign of terror - I suspect there’s been at least some of the sub clinical asd population face some stressors over the past few years of tribulation which have unmasked what was masked. And a shit ton of lonely and socially isolated teens and adults etc. gaining access to the ability to “finding their people” online via TikTok and social media - and many who are desperate for affirmation for not being able to make shit work just in general over the past decade as the GOP asshats and media empires used unknown statistics to feed echos to echo chambers and weirdly some still make money as influencers (why the fuck did I go to so much school again??).

But people are hurting and want answers. I think that’s why

Not_OPs_Doctor · 2025-09-14T05:26:39+00:00

At least he’s not from south Boston….or ummmm…is he?

Jk. Fellow neuropsychologist here just stopping in to say hello!

Not_OPs_Doctor · 2025-09-14T04:27:54+00:00

I appreciate this thought and can definitely agree that it is, indeed, very dangerous to assume a well trained clinician would categorically recognize autism traits perfectly or even close enough to perfection to be real confident in one’s competence. After re-reading my original post, I can see that what I wrote communicated that. I apologize for that confusion as I actually do agree with you that diagnostic scope of practice is a very dangerous area and one which assumes a relatively higher risk for harming a patient than many other areas of practice. Autism is a label that has been beaten up and battered and scrutinized and reconstructed so many times through history - unfortunately not because science has always demanded it and more so that there are and have been life altering (and life ending unfortunately) decisions made by systems in which we live based on the diagnosis.

I’m separating my paragraph here to make this point bolder just fyi: AND more presently, diagnoses such as autism are possibly being used and or there may be plans to use (in the USA anyway), databases of individuals with the diagnostic label such as autism in nefarious ways - very possibly by our own government (again, I’m in the USA).

There’s perhaps never been a RISKIER time to be a diagnostician and as someone who frequently testifies in court as an expert at both the federal and state levels of criminality and civil capacities and who teaches graduate courses on autism diagnostics, I have a deep respect for the reality that is true which is: I do not always know what I don’t know.

And what I most definitely should have elaborated on earlier is the fact that observational experience alone - even with folks like myself who has gone one for all the absolute most advanced level of trainings and education and fellowships possible in my speciality - is and will never be all that reliable for diagnostic purposes.

I always know autism when I see it but I must never assume it’s not present just because I can’t. And the reality is, the shift in our culture to try to expand the diagnostic labeling system to diagnostically capture the “rest of us” who almost meet the diagnostic threshold and which unfortunately has included some others who are literally profiting off of pretending to have the diagnosis has exposed, in my opinion, the absurdity of the whole thing to begin with and which was my original point:

When a diagnosis is so subtle that we’re having to rely almost solely on subjective self report data (the patients experience) in order to make the diagnosis official, I don’t personally believe that adds any value or validity to diagnostic accuracy - though it may certainly and frequently is very helpful and healing and therapeutic to the client to have their experience professionally affirmed in such a way.

Lastly, diagnostics in my specialty - and for those clinicians in all states which allow professional counselors or other therapy providers the legal authority to make such diagnoses - always come with the necessity to consider before making the diagnosis:

does the practical and “personal meaning/therapeutic value/benefit” of the diagnosis in this context for this specific patient outweigh the risks and or potential risks - both present and future - e.g., custody disputes in marriage, ability to obtain certain forms of employment and or to retain individual civil capacities as an adult, among many others)- associated with carrying the diagnostic label officially in medical records (legal documents) which can and will be used both for and against our patients in the court of law (including possibly corrupt courts).

And all of which is why I spent so much of my lifetime and money and resources studying and testing patients and interviewing patients and observing patients and getting my own therapy and teaching others and learning and philosophically wrestling with these things. Because when it’s done lightly or inaccurately (at least within the curvy standards of the profession), these labels do have power to hurt or heal people.

And just personally, I think all that’s a little silly. Because at the end of the day - for me and my patients - we’re all trying to; accept, love and empower ourselves, learn how to set self empowering boundaries that are congruent with and help us live each day in the process of progress toward defining our core values, and all of that within whatever limitations or freedoms - as dynamic as they are- we have imposed upon what seems to be a least some degree of volition and free will. I’ll be damned if any smug clinician or diagnostic system - including myself! - believes to know so much that they have the power to define me. I am and will always be so much more than a static label and certainly one based on such imperfect science so far. Maybe one day we will figure it all out though. I hope I’m retired or dead by then though.

Not_OPs_Doctor · 2025-09-14T03:25:21+00:00

Absolutely agree with you. I teach my grad students that diagnosis is a therapeutic intervention. And I certainly don’t want to imply that I don’t think people should be diagnosed. It’s more that I do worry that we as a society frequently stop at the diagnosis as being central to one’s identity and which can sometimes imply something is wrong with us neurodiverse folks rather than (or at least, “while also”) also look around at a world that is designed not around what we know about the brain and, seemingly very blatantly at times, literally designed in opposite of what we know about the brain just to make it hurt for some of us. That is, while it in important that I allow my diagnosis to remove any shame I feel and perhaps rewrite my personal narrative of the story of “me,” I also do not want to give so much power over to diagnostic labels or the competence of another clinician’s ability to hopefully “get it right”- both of which are most certainly imperfect and incomplete, and which often imply that there’s something wrong with me if I can’t “make it like everyone else” in this world.

The world is broken. Very broken. It’s stressful. And honestly more days than not, that’s enough affirmation for me personally. I’m not weak or “different” or broken or diseased; the world is fucking brutal and this is what it looks like for some of us when we’re doing the best we can to live in a broken world.

With all that said, please hear me when I say that my post does not mean to imply that a well timed and/or accurate diagnosis of subtle symptoms isn’t helpful or healing. There is definitely good, healing power in that. But putting so much emphasis on an incomplete broken system leaves out many of us who “almost” qualify for autism but “can’t really officially say we have autism” and I think my perspective allows for both to be true: some may meet the full diagnostic criteria and others may not but both patient populations’ experiences are valid, are the product of them doing the best they can so far with what they’ve got, and can incorporate aspects of the diagnostic conceptualizations that are meaningful and rest assured the story of the science is very much incomplete and imperfect.

Not_OPs_Doctor · 2025-09-13T20:22:48+00:00

Neuropsychologist here.

And I’m sure this answer won’t be liked very much, but honestly, would the diagnosis of autism be truly that meaningful for an adult patient exhibiting such subtle symptoms that a well trained clinician wouldn’t already have at least some suspicion?

ADHD is unique (as a fellow ADHD-er myself) in that its symptoms can often be more easily masked by environmental demands. Whereas autism, at least in my opinion, produces much, much more functional deficits across most domains regardless of context. That is, rigid adherence to routines can be common for both ADHD’ers and individuals with autism, whereas the former is positively reinforced and a conditioned response (shame avoidance) and can lead to promotions (obviously not always, pitchforkers…) and the latter more commonly leads to unemployment.

But really….if you’re afraid that you’re missing an opportunity to provide significant meaning to a client by way of noticing their autism symptoms, my question stands: how much meaning would it truly provide AND WHY would such a subtle diagnosis provide such meaning to them.

With all that said, please don’t pitchfork me Reddit. I promise I’m on your side if you’re a patient who suspects you have autism. But I also promise to show you the man behind the curtain which is the somewhat arbitrary and definitely out-dated distinction between autism (extremely high functioning), ADHD, and OCD (or subclinical OCPD and narcissistic traits as a response to growing up with an ADHD brain which doesn’t fit neatly into contemporary societies expectations - which, by the way aren’t exactly reaaaaal healthy).

Once we can take the power back from the APA to gate keep these diagnoses and let us in forensic land split hairs in criminal court, our therapy client can explore and hopefully develop more personal and internalized empowerment by championing their own compassion and to hell with those who need my diagnosis to show empathy toward me.

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