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Executive functioning and the "Justice" of work-arounds

11/27/2021

CONJECTURE

Executive Functioning -- NOT IQ is one of the BIG ISSUES driving --- HOMELESSNESS and INCARCERATION.
It does become even more problematic when the EMOTIONAL INTELLIGENCE folks want to say:
- Your IQ or Talent really aren't very important
- Pay Us to Teach You to BE LIKE US.
  - That can be a lot harder climb than what anybody thought --- because the EXECUTIVE FUNCTIONING DIFFERENCES are often related to DEVELOPMENTAL and EPIGENETIC DIFFERENCES.
  - This is the TRUE BRILLIANCE of our CURRENT APPROACH: we're not going to give you CREDIT for your TRADITIONAL INTELLIGENCE --- but we are going to use it against you.

ON THE OTHER HAND

Our great tragedies of the FALL of the BIG MAN or WOMAN are often the result of INTELLIGENT and/or TALENTED people who didn't realize they had EXECUTIVE FUNCTIONING CHALLENGES --
- Life could turn into one big cover-up.
Further, if you have been in this hierarchical society -- you probably have been subject to some "SUPERIOR'S" temper tantrums.

EXECUTIVE FUNCTIONING -- The DELICATE Approach

Ironically, Executive Functioning Challenges often do come with HIGH IQ and or TALENT.

That's because a lot of the individuals do have HYPER-PLASTIC brains.
- So its not that there is no NEURO-PLASTICITY going on --- there is generally much more than the average, BUT
- The system may NOT be sufficiently "weakening neighboring synapses" --- so there is a FLOOD of INFORMATION coming in all the time and it can "OVERWHELM" the person. (see the MIT article below right).

The first thing is to acknowledge the INTELLIGENCE and Talent that the Neuro-Diverse Person

possesses.

I think it is hard for NEURO-DIVERSE people to TRUST if Neuro-Typicals can't do that.
Further, the truth is --- those NEURO-DIVERSE STRENGTHS are important KEYS to RECOVERY.

ADDRESSING EXECUTIVE FUNCTIONING

without Making it Worse -- WORKAROUNDS

The SOCIETY is faced with a CONUNDRUM when it comes to addressing EXECUTIVE FUNCTIONING:

By and large we're not doing a lot of PREVENTATIVE IDENTIFICATION and SUPPORT.
We tend to have a lot of CRISES
That has a lot of social implications -- it has BIOLOGICAL IMPLICATIONS
By the time one gets to the "PSYCHIATRIC DISORDER" -- you do have a HYPER-CONNECTED BRAIN.
- Well, NOW is NOT the TIME to try to CONNECT the wiring in the brain even further.

WORK-AROUNDS

"Work-Arounds" are the PRACTICAL ALTERNATIVE in many cases
"WORKAROUNDS" are what Dr. Gail Saltz recommends in her book "The Power of Different."
We're not trying to CHANGE the person, we're trying to WORK-AROUND any DEFICITS.
AND MAXIMIZE Strengths.
That can be healing in and of itself and give the person the BREAK they need to be a valued part of the COMMUNITY.

The more that NEURO-DEVELOPMENTAL and PSYCHIATRIC DISORDERS are recognized as:
- Often beginning In Utero and
- Having an Epigentic Life of their own
The more they won't be seen as issues of "MOTIVATION"
Further, the "HYPER-CONNECTED BRAINS" of people with PSYCHIATRIC DISORDERS to me tell a story of UNWITTING ABUSE.

MIT scientists discover fundamental rule of brain plasticity

Study reveals how, when a synapse strengthens, its neighbors weaken. (2018)

Our brains are famously flexible, or “plastic,” because neurons can do new things by forging new or stronger connections with other neurons.

But if some connections strengthen, neuroscientists have reasoned, neurons must compensate lest they become overwhelmed with input. [Val's Note: I think some people with "Neuro-Developmental" and "Psychiatric Disorders" are getting overwhelmed with "input"].

In a new study in Science, researchers at the Picower Institute for Learning and Memory at MIT demonstrate for the first time how this balance is struck: when one connection, called a synapse, strengthens, immediately neighboring synapses weaken based on the action of a crucial protein called Arc.

Epistemology, Psychiatric Disorders & the Law

11/16/2021

Temple Grandin and probably a lot of other people are going to ROLL THEIR EYES at such a $5 word as "epistemology" --- and plead -- COULD WE JUST DO SOMETHING PRACTICAL?

I probably would have been in that group most of my life and certainly before I saw the failure of the Mental Health Profession to REFORM ITSELF after the National Institute of Mental Health (and subsequently over 600 Research Institutions) called into question the scientific validity of the DSM 5.

Ironically, the BARRIER to REFORM has been PERFECTIONISM both on the part of the American Psychiatric Association and the National Institute of Mental Health (NIMH).

I was thrilled when I heard about NIMH's Research Domain Criteria Program (RDoC) that at least initially was designed to replace the DSM.

BUT what is the MISSION of RDoC -- we have this great "MATRIX" and when we KNOW EVERYTHING --- we'll get back to you.

MEANWHILE --- DSM "categories" are alive and well -- certainly in the Criminal Justice System, most specifically in the designation and understanding or lack of understanding of "ANTI-SOCIAL PERSONALITY DISORDER."

Our understanding of "PERSONALITY DISORDERS" has been pretty fuzzy and generally not linked to "biology" -- exactly --people who just couldn't get it together -- maybe that included a bad childhood or environment. In the case of ANTI-SOCIAL PERSONALITY DISORDER, doing bad things.

Is it any wonder that at least one prominent Historian of Psychiatry questioned whether PERSONALITY DISORDERS were Psychiatric Disorders at all.

At least, some clinicians have pointed out that the historical development of "PERSONALITY DISORDERS" didn't look SCIENTIFIC.

SUBSEQUENTLY, at least some RESEARCHERS AROUND the WORLD are viewing "ANTI-SOCIAL PERSONALITY DISORDER" as a form of the NEURO-DEVELOPMENTAL DISORDER ADHD.

Further, NEURO-DEVELOPMENTAL DISORDERS and PSYCHIATRIC DISORDERS look BLURRED with most people with a traditional NEURO-DEVELOPMENTAL DISORDER having at least 1 co-morbid "PSYCHIATRIC DISORDER."

Daubert Standard

Definition

This is the standard used by a trial judge to assess whether an expert witness’s scientific testimony is based on scientifically valid reasoning that which can properly be applied to the facts at issue.

Overview.  This standard comes from the Supreme Court case, Daubert v. Merrell Dow Pharmaceuticals Inc., 509 U.S. 579 (1993).

Under the Daubert standard, the factors that may be considered in determining whether the methodology is valid are: (1) whether the theory or technique in question can be and has been tested; (2) whether it has been subjected to peer review and publication; (3) its known or potential error rate; (4)the existence and maintenance of standards controlling its operation; and (5) whether it has attracted widespread acceptance within a relevant scientific community.

The Daubert standard is the test currently used in the federal courts and some state courts. In the federal court system, it replaced the Frye standard, which is still used in some states.

Source:  Cornell Law School Legal Information Institute

"Legal epistemology examines when and why evidence has a probative value; that is, it investigates how evidence makes a litigated claim more likely. It illuminates what reasons—moral, political, economic, practical, epistemic—justify excluding probative evidence." Feb 27, 2019

Legal Epistemology - Philosophy - Oxford Bibliographies

The RATIONAL PROBLEMS in Criminal Justice with respect to "ANTI-SOCIAL PERSONALITY DISORDER" are beyond DISTURBING.

And yet we don't have PERFECT KNOWLEDGE and we're unlikely to have PERFECT KNOWLEDGE in our lifetimes or the lifetimes of those victims and defendants relying on the LEGAL SYSTEM for JUSTICE.

We do have MORE KNOWLEDGE.

If we wait for the LEGAL SYSTEM to solve this by themselves --- it is going to be akin to waiting for RDoC.

We need something more practical in terms of ramping up a PUBLIC HEALTH APPROACH TO CRIMINAL JUSTICE that could be greatly facilitated through Olmstead Planning.

I'm not against RDoC (I'm for it) and I'm not against the Legal System (I'm for it) --- but we need to address the problem of CRIMINALIZING NEURO-DEVELOPMENTAL DISORDERS --- NOW ---while ensuring and improving SAFETY --- NOW.

The JUSTICE EQUATION in MENTAL HEALTH

11/9/2021

(in the US we should have Parity, Olmstead & Medicaid Network Adequacy -
BUT those LAWS are not effectively enforced at a practical Federal Administrative Level)

On top of that, we have a Mental Health Profession using an OUTDATED diagnostic manual.

There's a lot driving the Mental Health Crisis in:

Colorado
Nationally, and
Globally

Further, there are local and regional drivers --- everything from:

War to
Complications associated with High Altitude

Seemingly two of the BIG DRIVERS involving the IMMUNE SYSTEM are:

The Old Friends Hypothesis, and
DEVELOPMENTAL INFLAMMATION
- To make matters more complicated, DEVELOPMENTAL INFLAMMATION (low grade inflammation is associated with "intelligence")
  - General intelligence is associated with subclinical inflammation in Nepalese children

SIGNIFICANT DEVELOPMENTAL INFLAMMATION is associated with NEURO-DIVERSITY

Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review (ADHD, Autism & Tourette Syndrome)

SOME SPECIAL ABILITIES

6 Strengths & Benefits of ADHD (Medical News Today)
Five Research-Based Strengths Associated with Autism (Stages Learning)
Strengths of Tourette Syndrome (Univ. of Florida)

PSYCHIATRIC DISORDERS

ADHD Comorbidities & Related Conditions (ADDitude online)
- "Roughly 80 percent of those with ADHD are diagnosed with at least one other psychiatric disorder sometime during their life."
Autism’s Clinical Companions: Frequent Comorbidities with ASD (Children's Hospital of Philadelphia)
- "As many as 85% of children with autism also have some form of comorbid psychiatric diagnosis, and 35% are taking at least 1 psychotropic medication as treatment."
Tourette syndrome and other neurodevelopmental disorders: a comprehensive review (Child & Adolescent Psychiatry & Mental Health)
- "The available evidence suggests the following: (1) neurodevelopmental comorbidities in TS are the rule, rather than the exception; (2) attention deficit/hyperactivity disorder (ADHD) is the most frequent; (3) there is a continuum from a simple (TS + ADHD or/and learning disorder) to a more complex phenotype (TS + autism spectrum disorder)."

So generally as a population we've liked the special abilities and NOT the psychiatric disorders.

But we've been selecting for those "SPECIAL ABILITIES" and there are now more and more people with BOTH those "SPECIAL ABILITIES" and "PSYCHIATRIC DISORDERS."
- Those "SPECIAL ABILITIES" can be academic, athletic or creative.
- The "PSYCHIATRIC DISORDERS" are generally not distinct as presented in the DSM 5 -- but tend to be "BLURRED" -- which makes sense if a common mechanism is often MATERNAL IMMUNE ACTIVATION.
- Both the "SPECIAL ABILITIES" and "PSYCHIATRIC DISORDERS" appear to be related in part to differences in Sensory and Information Processing.

MENTAL HEALTH BY THE NUMBERS

The scope of the burden of "psychiatric disorders" in Colorado, the US and the World is HUGE.

So when the State of Colorado is proposing 62 new beds and Mental Health Colorado says we need over 2,800 new beds --- we see the problem.
Further, we need thousands more SUPPORTIVE HOUSING SLOTS ---- it cost the State of Colorado over $1.5 million dollars for 25 new Supportive Housing apartments.
In the LONG TERM -- we've got to have better UNDERSTANDINGS and TREATMENTS and it appears that's coming and may be here for the NEXT GENERATION.
In the meantime, we've got to get better at working with what we've got:
- Often people with SIGNIFICANT EXECUTIVE FUNCTIONING CHALLENGES, and
- ABILITIES in select areas that are often higher than the NORM.

Transitional/ Translational Justice Monday

Executive functioning and the "Justice" of work-arounds

Epistemology, Psychiatric Disorders & the Law

The JUSTICE EQUATION in MENTAL HEALTH

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